European Journal for Dental Implantologists

ISSN 1862-2879 I Vol. 10 I Issue 3/2014

EDI JOURNAL
EDI Journal 3/14

TOPIC

From X-ray film

to digital radiology

»EDI News: 25 years of BDIZ EDI · Interview with Professor Joachim E. Zöller · 8th Euro-
pean Symposium of BDIZ EDI · Coming up: 10-year anniversary of the Expert Sym-
posium · Restructuring of the EDI Journal editorial team »European Law: ECJ: “Legal
highs” are not medicinal products »Clinical Science: Technological change in implanto-
logical diagnostics: From X-ray film to digital radiology »Case Studies: Treatment of
patients with chronic periodontal disease

The year 1989 was an eventful year. Thinking about the found-
ing year of the association, we of BDIZ EDI sometimes forget
that that was the year when the Berlin Wall fell and Germany
set out on its path to reunification. This was achieved without
violence or street fighting, which showed clearly how much
can be achieved with peaceful resistance.
In dentistry, a momentous event had occurred a few years
earlier. In 1982, Professor Manfred Strasbourg of the German So-
ciety of Dental, Oral and Craniomandibular Sciences (DGZMK)
formally extended scientific recognition to the still young dis-
cipline of oral implantology – a discipline that was to revolu-
tionize restorative dentistry. But those who believed that this
recognition would usher in a new era in dentistry saw their
hopes thwarted. Oral implantology – developed by practitio-
ners – resulted in heated discussions between dentists in pri-
vate practices and in academia. So the surgical and prosthodon-
tic fundamentals taught at the universities should suddenly be
invalidated by oral implantology?
In the midst of this conflict, the standard fee schedule for
dentists that appeared in 1988 was the first one to acknowl-
edge implant treatment, giving rise to the realization that im-
plant dentistry also had to be assessed from a business point
of view. The establishment of the BDIZ was preceded by many
rounds of discussions with the universities and by much frus-
tration on the part of established implant dentists. Eventually,
18 of them assembled in Frankfurt on 30 September 1989 to
found BDIZ. Chairman at that time was Professor Egon Brink-
mann. However, the discussions continued. For a long time, the
“powers that be” did not perceive BDIZ as the professional and
legal representation of dentists working in the field of oral im-
plantology, but dismissed it as yet another implantological so-
ciety. But that was exactly what BDIZ was not. This was the first
time an association – unlike the scientific societies – addressed
legal and business issues of the profession, which quickly led to
confrontations with the state dental associations in Germany.
The rapprochement between BDIZ and the state dental as-
sociations was a long process that proceeded in a succession
of small steps: joint lists of court experts, expert meetings to
spread implantological knowledge, a first dental interpreta-
3
EDITORIAL
Feeling the pulse
of the times
tion of the fee schedule for dentists by the BDIZ. But there were
always setbacks as well. A common interpretation of the fee
schedule by BDIZ, the state dental associations and the health
insurance companies did not materialize.
BDIZ EDI – which added “EDI” to its name in 2002 to under-
score its European orientation – has never shied away from
conflict. However, resistance today no longer comes from with-
in the dental profession. Implant dentistry has long been an es-
tablished procedure that is very much in demand by patients.
Today, BDIZ EDI also works closely with the universities. The
best example is the cooperation with the University of Cologne
in the joint Curriculum Implantology, which has guided young
dentists through their first steps in implantology since 2005;
it has since given rise to curricula with substantively identical
content being developed and implemented outside Germany.
The University of Cologne also drafts the working papers for
the European Consensus Conference (EuCC) on Oral Implan-
tology, which has met in Cologne every year since 2006. This
fruitful connection between the association and the university
benefits all dentists. The guidelines based on the university’s
draft are available to all dentists in Europe.
One day it might be some new regulations, the next day it
might be the health insurance companies, some other day it
might be German or European politicians that demand or cre-
ate a legal and practical framework that adversely affects the
work of dentists – and not just of oral implantologists either.
Today, BDIZ EDI acts as a task force responding to political devel-
opments in Europe, offering its expertise to all practicing den-
tists. A recent good example of this is BDIZ EDI’s comments on
pitfalls in materials purchasing and materials billing – such as
mentioned by the so-called Sunshine Act in the United States.
Twenty-five years after its foundation, new challenges con-
tinue to arise that BDIZ EDI must face and wants to face. The
successful work of the past years gives us the necessary mo-
mentum to address these challenges.
Sincerely,
Christian Berger, Kempten/Germany
President of BDIZ EDI
4
TABLE OF CONTENT

48 70

From X-ray film to digital radiology Digital complex implant rehabilitation using an intraoral scanner

EDI News 70 What can we achieve?

Digital complex implant rehabilitation
10 Serving implantological practitioners for 25 years
using an intraoral scanner
BDIZ EDI and oral implantology
78 Closed hydraulic sinus floor elevation with
15 Wholehearted commitment to the cause
simultaneous implant insertion
BDIZ EDI Board members speak their minds
Focus on a new technique
18 Anniversary salutations
84 Proven quality
20 We need more guidelines in oral implantology Characterizations of MIS implant surfaces
Critical thoughts by and with Professor Joachim E. Zöller,
86 Fast and reliable
Vice President of BDIZ EDI
Immediate implant-supported restoration of
22 Barcelona – a different view a single-tooth gap using a chairside CAD/CAM system
2nd International Symposium of Quintessence
Publishing/8th European Symposium of BDIZ EDI
Business & Events
26 10-year anniversary of the Expert Symposium
90 5th International Camlog Congress in Valencia
“Peri-implant inflammation –
misfortune of fate or avoidable?” 94 Nobel Biocare DACH Symposium in Munich
28 Implantological boomtown 98 5th Annual NYU College of Dentistry Global Implantology
Impressions from Hyderabad Week by Zimmer Dental and NYU in New York
32 Restructuring of the EDI Journal editorial team 100 Annual Meeting of AKOPOM and AGKI in Bad Homburg
34 European Consensus Papers online 104 Interview with Silvia Albiac,
36 Certification as an EDA Expert in Implantology Managing Director at Bego Iberia

40 Taking leave of Veronika Rehers-Bender 106 In memoriam Dr Peter Geistlich

42 Europe Ticker 107 Zeramex (T)apered cleared for U.S. markets

108 Interview with Stephan Weber,
European Law General Manager of Implant Direct

46 ECJ: “Legal highs” are not medicinal products 110 Straumann Pure Ceramic Implant
for metal-free implant treatment
Clinical Science 111 ICX-templant conquers China
48 From X-ray film to digital radiology 112 The Dentaurum Group’s new website is online
Technological change in implantological diagnostics 113 Study proves excellent properties
of Roxolid from Straumann
Case Studies
58 Treatment of patients with chronic periodontal disease News and Views
Current aspects in the treatment of periodontally 3 Editorial
diseased patients with angulated implants
6 Imprint
8 Partner Organizations of BDIZ EDI
Product Studies
114 Product Reports
64 Quality long-term implant treatment
118 Product News
The one-piece implant: a cost-effective and predictable
treatment option 120 Calendar of Events/Publishers Corner
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IMPRINT

Scientific Board

Dr Iyad Abou-Rabii, Dr Maher Almasri, Professor Alberico Dr Marco Degidi, Dr Eric van Dooren, Professor Rolf Ewers, Professor Antonio
Coventry Coventry Benedicenti, Genoa Bologna Antwerp Vienna Felino, Porto

Professor Jens Fischer, Dr Roland Glauser, Professor Ingrid Dr Detlef Hildebrand, Dr Axel Kirsch, Professor Ulrich Professor Edward
Basel Zurich Grunert, Innsbruck Berlin Filderstadt Lotzmann, Marburg Lynch, Coventry

Dr Konrad Meyenberg, Professor Georg Dr Jörg Neugebauer, Professor Hakan Professor Georgios Luc Rutten, MDT, Patrick Rutten, MDT,
Zurich Nentwig, Frankfurt Landsberg a. Lech Özyuvaci, Istanbul Romanos, Rochester Tessenderlo Tessenderlo

All case reports and scientific documentations

are peer reviewed by the international editorial
board of “teamwork – Journal of Multidisciplinary
Collaboration in Restorative Dentistry“.
Dr Henry Salama, Dr Maurice Salama, Dr Ashok Sethi, Ralf Suckert, Professor Joachim E.
Atlanta Atlanta London Fuchstal Zöller, Cologne

Imprint
Association: The European Journal for Dental Implantologists (EDI) is published
in cooperation with BDIZ EDI.
Publisher Board Members: Christian Berger, Professor Joachim E. Zöller,
Dr Detlef Hildebrand, Professor Thomas Ratajczak
Editor-in-Chief (responsible according to the press law): Anita Wuttke,
Phone: +49 89 72069-888, wuttke@bdizedi.org
Managing Editor: Simone Stark, Phone: +49 8243 9692-34,
s.stark@teamwork-media.de
Project Management & Advertising: Marianne Steinbeck, MS Media Service,
Badstraße 5, D-83714 Miesbach, Phone: +49 8025 5785, Fax: +49 8025 5583,
ms@msmedia.de, www.msmedia.de
Publisher: teamwork media GmbH, Hauptstr. 1, D-86925 Fuchstal,
Phone: +49 8243 9692-11, Fax: +49 8243 9692-22, service@teamwork-media.de,
www.teamwork-media.de
Managing Director: Dieter E. Adolph
Owner: Deutscher Ärzte-Verlag GmbH, Cologne (100%)
Subscription: Kathrin Schlosser, Phone: +49 8243 9692-16, Fax: +49 8243 9692-22,
k.schlosser@teamwork-media.de
Layout: Sigrid Eisenlauer; teamwork media GmbH
Printing: Gotteswinter und Aumaier GmbH; Munich
Publication Dates: March, June, September, December
Subscription Rates: Annual subscription: Germany € 40 including shipping and VAT.
All other countries € 58 including shipping. Subscription payments must be made
in advance. Ordering: in written form only to the publisher. Cancellation deadlines:
in written form only, eight weeks prior to end of subscription year. Subscription is
governed by German law. Past issues are available. Complaints regarding nonreceipt
of issues will be accepted up to three months after date of publication. Current
advertising rate list from 1/1/2014. ISSN 1862-2879
Payments: to teamwork media GmbH; Raiffeisenbank Fuchstal-Denklingen eG,
IBAN DE03 7336 9854 0000 4236 96, BIC GENODEF1FCH
Copyright and Publishing Rights: All rights reserved. The magazine and all articles
and illustrations therein are protected by copyright. Any utilization without the prior
consent of editor and publisher is inadmissible and liable to prosecution. No part of
this publication may be produced or transmitted in any form or by any means, elec-
tronic or mechanical including by photocopy, recording, or information storage and
retrieval system without permission in writing from the publisher. With acceptance
of manuscripts the publisher has the right to publish, translate, permit reproduc-
tion, electronically store in databases, produce reprints, photocopies and microcop-
ies. No responsibility shall be taken for unsolicited books and manuscripts. Articles
bearing symbols other than of the editorial department or which are distinguished
by the name of the authors represent the opinion of the afore-mentioned, and do
not have to comply with the views of BDIZ EDI or teamwork media GmbH. Responsi-
bility for such articles shall be borne by the author. All information, results etc. con-
tained in this publication are produced by the authors with best intentions and are
carefully checked by the authors and the publisher. All cases of liability arising from
inaccurate or faulty information are excluded. Responsibility for advertisements and
other specially labeled items shall not be borne by the editorial department.
Copyright: teamwork media GmbH · Legal Venue: Munich
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8
PARTNERS

Partner Organizations of BDIZ EDI

Association of Dental Implantology UK (ADI UK)

ADI UK, founded in 1987, is a registered charity committed to improving the standards
of implant dentistry by providing continuing education and ensuring scientific research.
It is a membership-focused organization dedicated to providing the dental profession
with continuing education, and the public with a greater understanding of the benefits
of dental implant treatment. Membership of the ADI is open to the whole dental team
and industry, and offers a wealth of benefits, education and support for anyone wishing
to start out or develop further in the field of dental implantology.

Ogolnopolskie Stowarzyszenie Implantologii Stomatologicznej (OSIS EDI)

OSIS EDI, founded in 1992, is a university-based organization of Polish scientific implan-
tological associations that joined forces to form OSIS. The mission of OSIS EDI is to in-
crease implant patients’ comfort and quality of life by promoting the state of the art and
high standards of treatment among dental professionals. OSIS EDI offers a postgraduate
education in dental implantology leading to receiving a Certificate of Skills (Certyfikat
Umiej˛etności OSIS), which over 130 dental implantologists have already been awarded.

Sociedad Espanola de Implantes (SEI)

SEI is the oldest society for oral implantology in Europe. The pioneer work started in 1959
with great expectations. The concept of the founding fathers had been a bold one at the
time, although a preliminary form of implantology had existed both in Spain and Italy
for some time. Today, what was started by those visionaries has become a centrepiece
of dentistry in Spain. SEI is the society of reference for all those who practice implantol-
ogy in Spain and has been throughout the 50 years, during which the practice has been
promoted and defended whereas many other societies had jumped on the bandwagon.
In 2009 SEI celebrated its 50th anniversary and the board is still emphasizing the im-
portance of cooperating with other recognized and renowned professional societies and
associations throughout Europe.

Sociedade Portuguesa de Cirurgia Oral (SPCO)

The SPCO’s first international activity was the foundation – together with their counter-
parts in France, Italy, Spain and Germany – of the European Federation of Oral Surgery
(EFOOS) in 1999. The Sociedade Portuguesa de Cirurgia Oral’s primary objective is the pro-
motion of medical knowledge in the field of oral surgery and the training of its members.

Udruz̆enje Stomatologa Implantologa Srbije-EDI (USSI EDI)

USSI EDI was founded in 2010 with the desire to enhance dentists’ knowledge of dental
implants, as well as to provide the highest quality of continuing education in dentistry.
The most important aims of the organization are to make postgraduate studies meet-
ing the standards of the European Union available to dentists from Serbia and the
region; to raise the level of education in the field of oral implantology; to develop fo-
rensic practice in implantology; and to cooperate with countries in the region striving
to achieve similar goals.
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EDI NEWS
BDIZ EDI and oral implantology
Serving implantological
practitioners for 25 years
BDIZ was founded in 1989 in response to the dispute over the German fee schedule that had taken place in
1988. To this day, the association does not see itself as a competitor but as a complement to the scientific
societies. It wants to create a link between scientific research and clinical practice. With its symposia and
guidelines, the association offers high-quality continuing education – in the interest of implant dentists in
private practice.
Looking back at the beginnings of BDIZ EDI, one
name unlike any other symbolizes commitment and
farsightedness: Professor Egon Brinkmann (†2009).
A practicing dentist in Oldenburg, he first be-
came known in 1973 as a co-founder of the Work-
ing Group for Endosseous Implant Procedures,
with the support of DGZMK.1 The objective of this
working group was to examine different implant
Professor Egon L. W. procedures for feasibility and practicability. Brink-
Brinkmann † mann taught far more than 1,000 practising and
academic dentists the various implant procedures
in the many surgical courses and seminars he held.
Brinkmann always placed tremendous emphasis
on private dental practitioners, as demonstrated
by his classification of indications in endosseous
implantology, proposed in 1973 and further refined
in 1976 and still a solid foundation of implant den-
tistry today. In 1976, he encountered his first ceramic
implant materials and recognized the possibilities
that this material offered – a topic that was to re-
main with him. He was also the one to perform
the clinical testing for the ceramic implants of the
Biolox group and inserted his first ceramic anchor
implant in 1976.
It is almost impossible to overstate the impor-
tance of Brinkmann’s work for the practice of oral
implantology in dental offices today. He has suc-
cessfully defended his views against resistance
from many quarters and built BDIZ EDI. It is thanks
to his commitment that the Federal Association
of Implant Dentists in Private Practice in Germany
1 Brinkmann AK, Brinkmann ELW. Geschichte der zahn-
ärztlichen Implantologie in Deutschland [History of
dental implantology in Germany]. 1995. 16–17.
(which is what the German abbreviation BDIZ
stands for) was founded in 1989.
The BDIZ founders
Side by side with Brinkmann in founding BDIZ
in 1989 were those 17 dental colleagues that were
no longer willing to let people who were living in
the past stand in the way of implantological treat-
ments. They were the ones who set the stage for a
practical approach to oral implantology. The BDIZ
founders include:
Dr Rolf Brandau †, Wilhelmshaven
Dr Rolf Briant, Cologne
Professor Egon Brinkmann †, Oldenburg
Dr Uwe Brosda, Mainz
Dr Helmut B. Engels, Bonn
Dr Hans-Joachim Foet, Bonn
Dr Hans-Joachim Habermehl, Frankfurt
Dr Hans-Jürgen Hartmann, Tutzing
Dr Stephan Hausknecht, Aachen
Bernhard Hölscher, Bochum
Dr Werner Hotz, Stetten
Dr Heiner Jacoby, Arnsberg
Dr Ulrich Kümmerle †, Schwäbisch Hall
Dr Klaus Müller, Sinn
Dr Rüdiger Oeltermann, Wilhelmshaven
Dr Uwe Ryguschik-Ott, Berlin
Dr Dieter Wallrapp, Margetshöchheim
Dr Lothar Winkler †, Thannhausen
Just how bitterly the struggle for recognition
of oral implantology in Germany continued even
after its scientific recognition by DGZMK in 1982 is
reflected in a text published by Brinkmann, Briant,
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Partners in Progress
12
EDI NEWS
Ehrl, Hartmann, Kümmerle and Streckbein in April
1991. It was based on an article by Willi Schulte in
Zahnärztliche Mitteilungen entitled “Future and
problems of dental implantology in Germany”. In
this article, Schulte attempted to appeal to the spirit
of mutual respect between scientists and prac-
titioners and to highlight the importance of oral
implantology for all stakeholders. An excerpt from
his assessment follows: “[…] These statements are
unlikely to fail to have a positive effect and open up
opportunities to end the pointless and totally unde-
sirable infighting.”
From the outset, oral implantology was tasked
not only to prove that it was more than just an aca-
demic approach but also to establish itself as an
alternative treatment modality worth recommend-
ing. Schulte also anticipated that “soon there would
be a forensic case before the courts where the de-
fendant would have to justify the non-performance
of an implantological treatment. This would finally
put an end to the eternal demand by health insur-
ers to document the medical justification or medi-
cal necessity of an implantological treatment.
[...] This is not to deny that differences of opinion
exist between the universities and implantological
practitioners. The way implant systems were evalu-
ated by eminent scientists in the past gives rise to
the impression that these were influenced by eco-
nomic interests that clouded their objective as-
sessment. It would be regrettable if this extended
The founders of BDIZ: (from left) Dr Rüdiger Oeltermann, Dr Rolf Brandau, Dr Rolf Briant, Bernd Hölscher, Dr Uwe Ryguschik-Ott, Dr Helmut B. Engels,
Professor Egon Brinkmann, Dr Hans-Joachim Habermehl, Dr Stephan Hausknecht, Dr Hans-Jürgen Hartmann, Dr Werner Hotz, Dr Heiner Jacoby,
Dr Ulrich Kümmerle, Dr Hans-Joachim Foet and Dr Lothar Winkler.
to scientific assertions and if scientists were to put
their reputation for objectivity at risk. The publicly
offered free implant treatments at various universi-
ties are also detrimental to the collegial consensus
between scientists and practitioners. […]”
European orientation
Professor Brinkmann’s two successors, Dr Hans-
Jürgen Hartmann (Tutzing) and Dr Helmut B. Engels
(Bonn), successfully guided the association through
the 1990s and into the new century. Under their lead-
ership, the BDIZ succeeded to establish the formal
Professional Focus on Implantology in 2001, against
the resistance of the state dental associations. The
Consensus Conference on Oral Implantology was
founded on the initiative of BDIZ. It is an umbrella
organization where the scientific societies, includ-
ing those of the oral and maxillofacial surgeons, join
forces to provide joint training and joint curricula
and help teachers and trainers cooperate. Its main
objective was, and is, to speak for all implantological
associations, first with regard to specialist training
and later, if sufficient agreement could be reached,
with regard to legal as well as scientific issues.
In 2002, the association changed its name – and
focus – to become BDIZ EDI, where EDI stands for
European Association of Dental Implantologists.
The term “scientific society” was included in the
BDIZ EDI statutes, but without sacrificing in any way
its traditional political orientation. The pioneering
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14
EDI NEWS
work performed by past presidents Brinkmann,
Hartmann and Engels and their colleagues on the
board was the foundation of today’s association
work.
The association today: strong and active
Meanwhile, the BDIZ EDI has over 3,000 members
in Germany and another 3,000 members in the rest
of Europe. Christian Berger (Kempten) and Professor
Joachim E. Zöller (Cologne) have been leading the
association since 2006. Dr Hans-Jürgen Hartmann,
a former chairman of BDIZ (1993–2000), said in an
essay in BDIZ EDI konkret (3/2009): 2 “Today’s BDIZ
EDI is a powerful association that represents the in-
terests of clinical oral implantologists in Germany
and Europe and investigates the practicality of new
products and procedures, but also the sense and
nonsense of new and existing rules and regulations
as they apply to the dental office. To make sure that
people – especially politicians! – listen to our points,
the association needs a strong president, as it has
had in Christian Berger since 2006. Berger knows
what we need to do to make our voice heard. That
the new GOZ dental fee schedule with its nega-
tive impact on clinical oral implantology was never
implemented is owed to his far-sighted prudence.
Many dental associations in Germany adopted
significant portions of the BDIZ EDI legal opinion
submitted to the German Ministry of Health.” (Edi-
tor’s note: The draft dental fee schedule presented
in 2008 by the Ministry of Health was unceremoni-
ously dropped – not least because of the well-sub-
stantiated criticism on the part of dentists.)
Fighting GOZ 2012
The BDIZ EDI initiated a constitutional complaint
against the German standard fee schedule for den-
tists that came into force in 2012. It was filed by six
dentists (including BDIZ EDI members Christian
Berger and Professor Joachim E. Zöller). The Federal
Constitutional Court having refused to hear the
case, the originators are now seeking legal recourse
through the regular courts.
EuCC Guidelines since 2006
Ever since scientific aspects and a scientific orien-
tation became a part of the BDIZ EDI statute, Pro-
fessor Joachim E. Zöller has been in charge of the
BDIZ EDI’s ambitious continuing-education com-
2 From BDIZ EDI mitment. In addition to the Annual Symposium
konkret, 3/2009,
and the European Symposium, the Expert Sympo-
“How It All Began”
by Dr Hans-Jürgen sium in Cologne deserves to be mentioned in this
Hartmann. context. Each year as spring approaches, this event
addresses a specific key issue within oral implantol-
ogy. And since 2006, the European Consensus Con-
ferences (EuCC) held immediately before the annual
Expert Symposiums have agreed on a consensus
on these issues that was then made available to all
dentists in the form of a guideline. The topic of the
most recent guideline is implant malpositioning.
BDIZ EDI provides support in many fields.
The Curriculum Implantology, developed and
held in cooperation with the University of Cologne,
is now in its 16th season. Similar curricula, based on
the Cologne modules, are now held in several other
European countries. In recent years, the iCampus
programme has targeted young professionals in
the field of implant dentistry – an attractive and
varied programme managed with dedication by
the project leaders Dr Detlef Hildebrand, who is also
Secretary General of BDIZ EDI, and Dr Dirk Duddeck.
Experienced dentists working with oral implants
may register for the EDA Expert in Implantology
certification exam via BDIZ EDI.
Committed to quality
The work of the BDIZ EDI Quality Committee is ex-
actly what its name suggests – committed entirely
to quality. It tests materials and publishes the
results in the EDI Journal – most recently it scruti-
nized the surfaces of sterile-wrapped implants
using scanning electron microscopy.
The credo of BDIZ EDI
A practical orientation is what guides the BDIZ EDI
Board to this day, true to the words of its founder,
Professor Egon Brinkmann: “Any dentist who has
obtained the requisite qualification should be able
to practice dental implantology in his or her own
practice.”
AWU

BDIZ EDI Board members speak their minds
Wholehearted commitment
to the cause
On the occasion of the 25th anniversary, the EDI Journal editors asked the members of the BDIZ EDI Board
about their commitment to the association. What is the driving force of these gentlemen (and the sole lady)?
Here are the answers.
Dr Heimo Mangelsdorf
Nürnberg
Treasurer since 1998
In the ever-changing framework of healthcare policy, the
BDIZ EDI Board under Presidents Hans-Jürgen Hartmann,
Helmut Engels and now Christian Berger has always had
to respond quickly, which has also been reflected in each
year’s budget figures. Our members have always support-
ed us in the relevant decisions. I am very grateful for that,
and not without pride. So much for the past. A peek into
the future: In recent years, I found that a majority of our
younger colleagues is rather resistant to the experience of
the “oldsters”. But it does not do to keep repeating all the
mistakes that were ever made! A good way to benefit from
the experience of more experienced dentists is our iCampus
project, which I hope will have the success it deserves.
Dr Stefan Liepe
Hannover
Managing Director since 2007,
Secretary since 2009
I am active in BDIZ EDI because no other professional or-
ganization offers that mixture of current information on
healthcare-related political topics, specific assistance with
billing and legal questions and good, up-to-date continu-
ing education.
15
EDI NEWS
Dr Renate Tischer
Bad Salzungen
Member of the Board since 2001
Our association was the one to guide dentists in private
practice toward oral implantology in the first place. I have
served on the Board for many years because I believe that
grassroots efforts for and with my fellow dentists are
meaningful. BDIZ EDI has helped secure landmark deci-
sions for dentists working with implants – such as the
recognition of a formal Focus of Professional Activity on
oral implantology.
Christian Berger
Kempten
Vice President since 2001,
President since 2005
I very much appreciate the commitment of the BDIZ EDI
members. They continue to be courageous and far-sighted.
This was evident in the rapid decision on the constitutional
complaint against the GOZ fee schedule. Our services
need to be adequately remunerated, and we want to give
our patients the best possible care. BDIZ EDI combines
many much-needed skills in a unique combination in a
unique association.
16
EDI NEWS
Dr Wolfgang Neumann
Philippsthal
Member of the Board since 2013
I am active in BDIZ EDI because I feel that in the associa-
tion’s work, the welfare and the interests of its members
are paramount. This is done by competent continuing edu-
cation in oral implantology itself as in practical fields such
as accounting and management, and not least by our jour-
nals, BDIZ EDI konkret and its English-language sister pub-
lication EDI Journal, all supported and assisted by sound
legal advice. This is the foundation of our expertise in all
our deliberations.
Professor Bernd Kreusser
Aschaffenburg
Member of the Board since 2001
I am on the Board because the association is always keen to
develop practical solutions for our colleagues. Of particular
interest are the accounting recommendations, which are
now increasingly consulted in legal proceedings or in dis-
putes with private insurers.
Dr Detlef Hildebrand
Berlin
Secretary since 2006,
Secretary General since 2009
Within BDIZ EDI, I am trying to advance a programme for
young implantologists, iCAMPUS, to share the field of oral
implantology with as many motivated young dentists as
possible in the future. Here, BDIZ EDI provides an unparal-
leled platform! To transcend national boundaries, we are
attempting to motivate and integrate our European col-
leagues within BDIZ EDI. Our visions include a European
implantological exchange programme and shared cur-
ricula and Master’s programmes. This is what BDIZ EDI
stands for – “wholesale and retail”.
Professor Joachim E. Zöller
Cologne
Vice President since 2005
I appreciate BDIZ EDI because it is one of the few associa-
tions to formulate scientific statements! Each year since
2006, the European Consensus Conference (EuCC) under
the auspices of BDIZ EDI has prepared a guideline to assist
implant dentists with current issues related to oral implan-
tology. The guidelines, available in German and in English,
offer recommendations on all kinds of issues, from diag-
nosis to surgical planning and implementation. This year’s
guideline, for example, addresses implant malpositioning
and how to avoid it. Last year, the EuCC created the CCARD –
Cologne Classification of Alveolar Ridge Defects to assist
in defining standards of treatment for bone augmentation.
The year before saw the publication of the Cologne ABC
Risk Score, which has had great resonance among implant
dentists because of its simple traffic-light design and be-
cause it delineates exactly where the “critical territory” be-
gins. All guidelines since 2006 are available free for down-
loading from the BDIZ EDI website.
Dr Jörg Neugebauer
Landsberg
Member of the Board, Chair of
the Q&R Committee since 2004
I am active in BDIZ EDI because to practice oral implantol-
ogy successfully, optimal treatment is not enough; issues
of health politics, insurance law and the legal environ-
ment also play an important role, and here especially the
cooperation with the manufacturers of medical devices.
Dr Peter Ehrl
Berlin
Member of the Board since 2013
I am active in BDIZ EDI because I want to help ensure that
oral implantology can continue to be practiced on a solid
foundation – in Germany and in Europe.
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18
EDI NEWS
Anniversary salutations
The development of oral implantology in
recent years has been as successful as it was im-
pressive. Initially viewed with much suspicion, im-
plantology must now be regarded as a fully estab-
lished, dynamic and forward-moving discipline of
dentistry. In the 25 years of its existence, BDIZ EDI
has contributed much to this remarkable develop-
ment and can be proud of the current high stan-
dards in oral implantology.
Dr Peter Engel
And there is no end in sight for this success story.
CAD/CAM-based solutions or reduced-diameter
implants are just two examples of the field’s inno-
vative power and performance. The interaction be-
tween practitioners and researchers has managed
to provide reliable long-term treatment alterna-
tives for patients and to increase their quality of life
significantly.
Oral implantology has long since arrived in den-
tal practices in Germany. But what with all the
justified complacency about innovations and new
When the German Association of Dental Im-
plantologists (BDIZ) was established in 1989, dental
implantology had only been scientifically recog-
nized for a few years, since 1982 to be precise. The
practitioners of the time immediately recognized
the advantages of the pioneering idea of artificial
tooth roots in the rehabilitation of edentulous pa-
tients. Lively discussions ensued not least because
the GOZ – the German fee schedule for dentists
Jan-Philipp Schmidt
treating private patients – had just been freshly
adopted, attracting attention to issues such as eli-
gibility for reimbursement and economic consider-
ations as a whole. The directors and members of
the newly formed association had set themselves
the goal of not leaving the field of oral implanto-
logy to oral and maxillofacial surgeons alone. In
pursuing this goal, they helped lay the foundation
for the rapid and successful spread of implant den-
tistry in Germany.
That with great success comes great responsibil-
ity is generally known, and so today’s BDIZ EDI is not
only committed to oral implantology in Europe, but
also to the long-term health of implants through
opportunities, we must not forget the focus of all
dental activities: the patient. Not everything that
is possible today also makes sense for the patient.
When providing implant treatment, the dentist
must act as a consultant and explore all the avail-
able treatment alternatives together with the
patient.
I am sure that BDIZ EDI will continue strengthen-
ing this important dentist-patient bond in the years
to come. Only in this way can we justify the high
esteem in which oral implantology is being held
among dentists as well as among patients. I wish
the association and its members every success for
the future.
Dr Peter Engel
President of the
German Dental Association (BZÄK)
proper maintenance in the dental office and in pa-
tients’ homes. Surfaces that, in the pioneering days
of implant dentistry, were important breakthroughs
when it comes to the attachment of osteoblasts are
unfortunately sometimes also a major headache in
terms of peri-implantitis today, as these surfaces
seem to be equally inviting to bacteria.
The long-term health of oral implants can only be
achieved by a team effort of implantologists, dental
hygienists and the patients themselves. BDIZ EDI
was a pioneering force in popularizing this stance
in Germany. We would like to thank the association
for its support of the Healthy Implant Coalition and
our campaign under the motto of “Implants need
maintenance”. We wish BDIZ EDI every success for
at least the next 25 years!
Jan-Philipp Schmidt
Dentist and Health Economist
Master of Oral Medicine in Implantology
CEO of the Healthy Implant Coalition
 19
EDI NEWS

The objective of the foundation of BDIZ in 1989
was to make oral implantology available to dentists
in private practice and to allow each and every den-
tist to actively practice oral implantology on their
own premises, following appropriate training.
One thing is certain; this initial idea was success-
fully implemented. And there are many more mile-
stones that the association can look back on after
all these years. BDIZ EDI has evolved into one of
the most important implantological associations in
Germany. And BDIZ EDI is not only active nationally
but also on a European level, making its voice clearly
heard in discussions of health policy issues and ad-
dressing current legal issues that affect dental prac-
tices – a commitment that benefits its members
and the industry as a whole. This is where BDIZ EDI
stands out from other associations in Germany.
Within the scope of this year’s symposium theme,
“Implantology 3.0 – today, tomorrow, and beyond”,
support for aspiring oral implantologists certainly
plays an important role. BDIZ EDI has created its
own programme, iCampus, where tomorrow’s den-
tists get a sound introduction into the field. And
then there is of course the association’s own Cur-
riculum Implantology, which has set benchmarks
for quality and practicality and has been immensely
successful.
A successful path we are called on to continue
following – today, tomorrow and beyond. For more
Dr Ralf Rauch
than 25 years now, BDIZ EDI has been a fixture in
the landscape of associations for oral implantolo-
gists. On behalf of the Working Group on Implanto-
logy of the VDDI, we would like to extend our con-
gratulations.
Dr Ralf Rauch
Chairman of the Working Group on Implantology
of the VDDI

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20
EDI NEWS
Critical thoughts by and with Professor Joachim E. Zöller, Vice President of BDIZ EDI
We need more guidelines
in oral implantology
What is the state of affairs in implant dentistry, and where would be room for improvement? The Editorial
Board spoke with Professor Joachim E. Zöller, Director of the Department for Oral and Maxillofacial Plastic
Surgery and the Interdisciplinary Department of Oral Surgery and Implantology at the University of Cologne.
Professor
Joachim E. Zöller Based on the accumulated knowledge of over 30 years
after the scientific recognition of oral implantology,
where do you see the challenges?
“Great progress has been made in oral implan-
tology over the past decades, and many patients
have been treated successfully and sustainably.”
I am sure all implant dentists would readily sign this
statement. I, too, believe that we have built an im-
mense body of basic knowledge. However, there are
still many questions for which there is not just one
single evidence-based answer but where one gets
a whole range of – albeit well-informed – profes-
sional opinions that certainly result in varying lev-
els of success: How many implants does a patient
need? What method should be used to rebuild a
bone defect? When should implants be placed?
What is the role of the patient’s medical history or
concomitant morbidity? How should the implant
be designed? What material should be used for im-
plants? What criteria should guide the fabrication
of the superstructure? How can a restoration best
be transformed as the patient gets older? Should
the restoration be fixed or removable? Where
should implants be placed? What treatment plan-
ning method should be applied? How can peri-
implantitis be avoided or treated? One could list
many questions like these, including the question
whether pricing is directly correlated with the qual-
ity of a system.
What is the reason for this lack of consensus?
This diversity of opinion of experts is also re-
flected in the fact that there are few statements
on these issues by industry-independent consensus
conferences. At least one positive exception that
definitively deserves mention is the European Con-
sensus Conference (EuCC) initiated by BDIZ EDI that
issues clear statements and recommendations at
annual intervals. Looking at the Association of the
Scientific Medical Societies (AWMF), we see that
more than 1,000 guidelines have been developed.
In the field of implantology, we find only four – on
implant-supported restorations after irradiation, on
implant-supported restorations in the edentulous
maxilla, on bone replacement materials and on in-
dications for CBCT. Given the large number of im-
plantological publications and conferences, this is a
rather modest harvest.
Why are we in this situation?
Because we have a plethora of published case
descriptions and methods, but they no longer really
get us anywhere today. Things were different in the
early days of implant dentistry, when “courageous”
practitioners set out to demonstrate that one actu-
ally can introduce a foreign body into the jawbone
that projects transgingivally into an oral cavity
densely populated with bacteria and fungi – and
still will be integrated into the bone. Those were
pioneering achievements at the time! Unfortunate-
ly, this is no longer enough these days. It doesn’t
help much if, for example, some American luminary
declares that “this works very well in my hands” –
or to paraphrase, “if it does not work for you, then
you’re doing something wrong!” But neither do we
have much to gain scientifically from observational
studies where success rates of 98 to 100 per cent
are reported. One invariably wonders if only young
and healthy patients were included in these studies.
In real life, we who are implantologically active in
hospital departments or in private practice mostly
meet elderly patients with various systemic diseases,
don’t we? Shouldn’t we demand a bit more scien-
tific precision, maybe even intellectual honesty?

So what should we get to work on?

Regardless of where you look in the world, there
is still a considerable lack of well-designed studies
that are meaningful. Of course, oral implantology
allows no randomized double-blind studies such
as those performed when investigating pharmaco-
logical substances. But we have enough valid meth-
odological knowledge on how to design an appro-
A-DE10001

priate study. I recommend studying the critical and

constructive reflections by Professor Franz Porzsolt
at the University of Ulm. Of course, the universities
must do more than they already have. Nevertheless,
such prospective studies usually require sample
sizes that can be achieved only by a multicentre ap-
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lent and internationally recognized speakers who
Bone Fixation
should continue to work closely together in the
EuCC. But maybe we can transcend that level and
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Conference on implant malpositioning held in Cologne
in 2014.
22
EDI NEWS

2nd International Symposium of Quintessence Publishing/8th European Symposium of BDIZ EDI

Barcelona – a different view

The competition was fierce at the time of the 2nd International Symposium in Aesthetic, Restorative and
Implant Dentistry organized by Quintessence Publishing and held jointly with the 8th European Symposium
of BDIZ EDI in Barcelona. In Valencia, only a few hundred kilometres away, a major implant manufacturer
was holding its World Congress at the same time. Although Barcelona is always worth a visit, the event
itself must still be “right”. And it was clear that this was so, because the programme compiled by
Professor Jaime A. Gil for the 800 participants in the Palau de Congresos de Catalunya was of excellent
quality in terms of content and didactics.

Aesthetic and restorative dentistry and, hence, also
oral implantology were in focus on the three days of
the congress. Day 1 addressed implant surgery and
its aesthetic aspects, day 2 took the audience deep-
er into the subject – quite literally so, as the topics
were bone augmentation and endodontics – while
day 3 was dedicated to dental restorations. The sym-
posium was hosted by Professor Jaime A. Gil (Bilbao),
who introduced the speakers and their presentations
and then guided the discussion with the audience
wisely and with an eye for important details.
Around 30 speakers presented the latest develop-
ments in restorative and implant dentistry with
a view to bringing aesthetic treatment results and
the necessary new technologies into focus, among
them Dr Steve Chu (New York), who showed how
prefabricated root-form inserts from the dental
laboratory were able to preserve the pre-extraction
subgingival contours in cases where the extracted
tooth cannot be used as a provisional. Based on sci-
entific evidence, Dr Jaime Jiménez García (Madrid),
lecturer at the Department of Periodontology and
Implant Dentistry at New York University, discussed
the right times for immediate, early and delayed
implant placement in the aesthetic zone using
different protocols, pointing out what analytic ap-
proaches are required for decision-making. An in-
terdisciplinary approach to treatment planning in
the aesthetic zone was presented by Dr Daewon
Haam (New York). He promoted the inclusion of
several specialties (orthodontics, periodontics, end-
odontics and prosthodontics) in the overall treat-
ment, not least in terms of improving the aesthetics
of a given case.
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24
EDI NEWS
The speakers of
the 2nd Interna-
tional Symposium
of Quintessence
Publishing/8th Euro-
pean Symposium
of BDIZ EDI.
Problems in the aesthetic zone
Dr Dennis Tarnow (New York) had conducted exten-
sive literature searches to put known, sometimes
well-proven treatment aspects to the test. As co-au-
thor of three books on aesthetic restorative dentistry,
he urged the participants to study the literature on
peri-implantitis therapy more closely to learn how
to distinguish fact from fiction when it comes to
tissue thickness in relation to biologic width and
implant position. For Dr Stefan Fickl (Würzburg),
university lecturer for periodontics, the manage-
ment of the extraction socket is the critical factor
in achieving a functional and aesthetically pleasing
result. Fickl presented scientific and clinical contro-
versies surrounding the extraction socket and dem-
onstrated treatment options. The presentation by
Dr Francesco Amato included a description of the
pros and cons of three different situations when
placing a single-tooth implant in the aesthetic zone
in terms of the condition of the alveolar socket and
the adjacent bone tissue. Dr João Carames (Lisbon)
spoke on implant-supported dentures in the eden-
tulous jaw and on the operative and prosthodontic
measures necessary to achieve a predictable result.
Always welcome and always popular is Professor
Christoph Hämmerle (Zürich) who lectured on the
proper handling of the extraction socket, critically
assessing new methods for ridge preservation and
weighing their advantages and disadvantages. When
stated by Hämmerle, a familiar truth sounded so-
bering: There is still no clearly defined strategy for
preserving the alveolar bone.
Another “heavyweight” among the speakers was
Dr Ueli Grunder (Zürich). He also keeps looking for
reliable scientific data, which, however, he had been
unable to find with regard to his topic, the solution
for long-term soft-tissue and bone preservation for
compromised extraction sites in the aesthetic zone.
Although the lack of adequate soft tissue is the
main cause of failure in the aesthetic zone, it does
not do to concentrate on soft-tissue management
alone, particularly since this requires the presence
of sufficient bone. Augmentation therapy continues
to be necessary. The objective must be to preserve
any newly generated tissue over the years. Grunder
concluded: “Bone is something you can never have
enough of!”
Dr Homayoun Zadeh (Los Angeles), director of
the periodontics programme for postdoctoral stu-
dents at the University of Southern California (USC),
explored the “transition” from teeth to implants,
looking for success factors from a biological, surgi-
cal and prosthetic point of view. He presented ways
to handle extraction sockets in delayed implant
placement and in patients with a thin periodontal
biotype.
The presentation by BDIZ EDI President Christian
Berger was devoted to risk management in implant
therapy and the avoidance of complications using
the Cologne ABC Risk Score developed by the Euro-
pean Consensus Conference of BDIZ EDI in 2012.
Here, the practitioner can use a simple ABC system
to evaluate the impending implant treatment and
to assess the potential risk using four partial scores:
medical history, local findings, surgical and restor-
ative. The overall patient assessment works as fol-
lows: If all partial scores are green, the patient case
as a whole is assessed as low-risk (A for “Always”). If
at least two of the four partial scores are yellow, the
patient case as a whole is assessed as medium-risk
(B for “Between”). If all four partial scores are yellow,
the patient case is assessed as increased-risk (C for
“Complex”). The same is true if at least two of the
four partial scores are orange and yellow. Berger
reminded the audience that the Cologne ABC Risk
Score could be downloaded, in German and in Eng-
lish, from the BDIZ EDI website: www.bdizedi.org >
English > Professionals > Guidelines.
Any attempt to do justice to all the presentations
and all the speakers must fail given the space limita-
tions. But overall, the 30 lectures and, especially, the
panel discussions led by Professor Jaime A. Gil were
of immense value to the approximately 800 partici-
pants. This was amply demonstrated by the lively par-
ticipation of the audience in the ensuing discussions.
AWU
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From start-up to star

True to our ZERAMEX® motto – more than just one implant – Convention schedule, 17 October 2014, Hotel Estrel
we have presented several innovations since its introduction
in 2009. A new product line, a new design and steady growth 12 noon Reception, lunch
are just three things we are particularly proud of. Moreover, 1 p.m. Welcome address and convention
with our focus on esthetic and metal-free implant restorations, opening, Jürg Bolleter, CEO,
we are absolutely in keeping with current trends and optimally Dentalpoint AG
fulfill the wishes of today’s patients. We will make use of this 1.15 p.m. “Innovation in white – the Zeramex®
outstanding position to inspire our customers and actively implant system”,
make multi-piece, screw-retained ceramic implants an ever- Dr. med. dent. Jens Tartsch
more central theme in dentistry. 2 p.m. “Histological comparative studies at the
University of Bern”,
For practitioners, ZERAMEX® means a secure and simple system Prof. Dr. sc. nat. Dieter Bosshardt
for implants, comprehensive support services and the continu- 2.40 p.m. “Ceramic implants – an interesting
ous provision of new products adapted to market trends. We challenge for OMF surgery”,
would be pleased to meet personally with all those interested Dr. med. Dr. med. dent. Thomas Mehnert
in order to familiarize them with ZERAMEX® and our high-quality 3.15 p.m. “Use of ceramic implants in cases of
service. For this we cordially invite you to join us at our tradi- titanium intolerance,
tional annual international convention in Berlin on October 17, Dr. med. dent. Elisabeth Jacobi-Gresser
2014. At the convention we will also present our new multi- 4.30 p.m. “Comprehensive digital workflow”,
piece, screw-retained ZERAMEX® P(lus) implants and discuss Dr. med. dent. Urs Brodbeck and
the latest developments in complete digital workflow. Markus Ried, COO/DSSC, Biodenta
5.15 p.m. 3 ZERAMEX® applications
Take-off with us and register now at: Dr. med. dent. Mario Kirste
www.zeramex.com/berlin Dr. med. dent. Michael Leistner
Dr. med. dent. Arnd Lohmann
6 p.m. End of the convention
26
EDI NEWS
“Peri-implant inflammation – misfortune of fate or avoidable?”
10-year anniversary
of the Expert
Symposium
BDIZ EDI has another anniversary to celebrate: the 10-year
anniversary of the Expert Symposium. Carnival in Cologne
provides an opportunity to celebrate – and it is traditionally
the framework when the experts meet in the Cathedral City.
The topic for 2015 will be “Peri-implant inflammation –
misfortune of fate or avoidable?”
In 2006, BDIZ EDI Vice President Professor Joachim
E. Zöller introduced and implemented the concept
of the Expert Symposium. At the very first Expert
Symposium, much new ground was broken. Zöller
and his team of presenters highlighted the subjects
of immediate restoration and immediate loading of
implants. The concept prevailed – despite the un-
usual date of the symposium: Since that first ses-
sion, BDIZ EDI has met the Sunday before Carnival
Monday rages in the streets of Cologne.
At the anniversary symposium, causes and treat-
ment options of biological complications around
implants will be the topic under discussion. On
Sunday, 15 February 2015, national and international
speakers from academia and clinical practice will
assemble at the Dorint Hotel (Heumarkt, Cologne):
• Professor Thomas Albrektsson,
University of Gothenburg, Sweden
• Dr Jörg Neugebauer, University of Cologne, Germany
• Professor Marc Quirynen,
University of Leuven, Belgium
• Dr Ralf Rößler, University of Marburg, Germany
• Professor Anton Sculean,
University of Bern, Switzerland
• Professor Henri Tenenbaum,
University of Strasbourg, France
In addition, the following speakers are requested to
come: Dr Tom van Dyke, University of Boston, USA,
Dr Eduardo Anitua, Bilbao, Spain, and Professor Jörg
Meyle, University of Gießen, Germany.
Inflammatory peri-implant changes often remain
undiagnosed in their initial stages, as older patients
are often accustomed to “bleeding gums” or be-
cause the initial stage of peri-implantitis is classi-
fied as a simple mucositis, which does not require
treatment. Various methods have been proposed
for treating peri-implantitis. The invited speakers
will present their personal preferences and com-
pare them with the published results of other spe-
cialists. The Scientific Director of the 10th Expert
Symposium will be BDIZ EDI board member Dr Jörg
Neugebauer (Landsberg).
On the day before the symposium, the European
Consensus Conference of BDIZ EDI will also discuss
the same topic with a view to reaching consensus
and providing guidelines. On Sunday night, BDIZ
EDI Vice President Professor Joachim E. Zöller, who is
also President of the “Grosse von 1823” Cologne Car-
nival Celebrations Committee – the oldest in that
city – invites all symposium participants to attend
the Sunday night Great Carnival Session – another
tradition of many years’ standing.
Science during the day, Carnival at night. For the
10th time, this will be the motto of BDIZ EDI in Co-
logne. The registration fee includes one ticket for
the Great Carnival Session, Gürzenich. Note: An early-
bird discount applies for registrations received on or
before 13 January 2015. Those who want to attend
this anniversary event are advised to register early.
More information is comig up soon on the website
www.bdizedi.org. NEU/AWU
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28
EDI NEWS

Impressions from Hyderabad, the fourth largest city in India

Implantological boomtown
Hyderabad is the archetype of a boomtown. Glittering skyscrapers in Cyber-City, biotechnology in Genome
Valley – and in between, a colourful variety of Indian life in the Old Town district of the 15-million metropolis
in the south of the subcontinent. In this emerging industrial city, oral implantology is on a remarkable up-
swing. The demand for high-quality continuing education is immense. In late July 2014, the 3rd ICOI South
Asia Implant Symposium was held here at the instigation of Dr Vikas Gowd, member of BDIZ EDI and the
first Indian Expert in Implantology (EDA).

ance at the pre-congress, where specific topics were

Welcome to India:
The 3rd ICOI South
Asia Implant Sym- More than 800 participants took part on the three
posium was held
days of the symposium, which was held under the
in Hyderabad.
motto of “The new limits of implant dentistry” and
was mostly dedicated to pushing the envelope
with new materials, technologies, experience and
evidence-based research and the search for the
gold standard in implant therapy and bone materi-
als and in the fields of aesthetics, peri-implantitis,
emergency care, and implant prosthetics. Dr Vikas
Gowd had succeeded in attracting more than 30 in-
ternationally renowned speakers to Hyderabad to
help quench the participants’ thirst for knowledge
in the field of implant therapy.
Support by BDIZ EDI
BDIZ EDI President Christian Berger, Dr Thomas Han-
ser, Dr Minas D. Levantis and Dr Eugene Marais were
among the speakers who made their first appear-
treated in greater depth. The main podium also fea-
tured Dr Daniel Rothamel, Dr Glenn Mascarenhas,
Dr Antonin Simunek, Dr Yaniv Rotem, Dr Lavi Sapozni-
kar and the Agnini brothers. For the first time, work-
shops were offered to explain the implications of CE
marking of medical devices to dental technicians in
more detail. In addition, a master’s programme for
dental technology was also inaugurated.
In the opening session, Dr F. D. Mirza, widely held
to be a pioneer in implantology in India, opened a
cornucopia of observations on the field then and
now, presenting cases he still follows today – some
of which are 30 years old. Next, Dr Mahesh Varma
spoke about the ethical aspects of marketing and
handling implants. Lieutenant-General Vimal Arora
spoke on “Redefining dental implantology in the In-
dian Armed Forces”.
Dr Vikas Gowd was the first dentist on the sub-
continent to become a Certified Expert in Implan-
tology (EDA), and he has been a member of the
BDIZ EDI of many years’ standing. Given this close
relationship with BDIZ EDI, its President Christian
Berger gave two lectures on two different days, pre-
senting the Guidelines of the 9th European Con-
sensus Conference of BDIZ EDI – the Cologne Clas-
sification of Alveolar Ridge Defects (CCARD) – and
the Cologne ABC Risk Score for implant treatment,
each underpinned with clinical case reports. At the
request of BDIZ EDI, Dr Daniel Rothamel had also
come to Hyderabad to talk about bone grafting
and the latest findings regarding bone substitute
materials.
The local media seized the occasion to report
extensively on implant therapy and on training op-
portunities for dentists. “Metro India”, in a major
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30
EDI NEWS

Hyderabad is definitely also a boomtown in the

In Hyderabad, oral implantology is on a remarkable upswing.
article, cited symposium organizer Dr Vikas Gowd,
who pointed out that the goal of the event was to
showcase the range of what is possible in implant
therapy today.
fields of biotechnology and stem-cell research.
These were the topics of Dr Dilip Deshpande from
Mumbai, who spoke about the future of implant
dentistry and recent advances in stem-cell re-
search.
A paradigm shift is currently under way in Indian
dental circles, where “implant” has become the new
buzzword among dentists. According to Dr Gowd,
most practices already cooperate with an oral im-
plantologist or are looking for one. There has been
a run on continuing-education courses. Hyderabad
has 6,000 practising dentists for a population of
over 15 million – in the whole of India there are
nearly 93,000 dentists for 1.2 billion people. On the
other hand, oral implantologists are grappling with
the problem of high cost, especially since the finan-
cial resources of most patients are limited.
AWU/Dr Vikas Gowd

The team around Dr Vikas Gowd (third from right) with Dr Daniel Rothamel (third from left) and Christian Berger
(second from right).

Portrait: Hyderabad
The Indian metropolis is the fourth largest city in India. An estimated 15 million
people inhabit the Old City and the metropolitan area. The 400-year-old Hyder-
abad is the capital of the states of Telangana and Andhra Pradesh. Hyderabad
was founded in 1590. The city’s population was predominantly Muslim, while
88 percent of India’s population are Hindu. After the annexation of the Hy-
derabad State by India in 1948, a large part of the Muslim elite emigrated to
Karachi in Pakistan. Nevertheless, the Muslim population is the highest of any
Indian metropolis, at almost 40 per cent.

Hyderabad is an industrial city. With the foundation of the “Genome Valley”,

Hyderabad has established itself as the centre of the biotech and pharma-
ceutical industries in India. Other industries include electrical and software,
as well as mechanical engineering. The northwestern district of Hyderabad,
where the information technology firms are clustered, is known as “Cyberabad”.
An elevated rail rapid-transit system is under construction and is expected to
be operational in July 2015.
Source: Wikipedia
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32
EDI NEWS
Restructuring of the EDI Journal editorial team
New Editor-in-Chief
Since 1 July 2014, EDI Journal, the professional implantological journal of BDIZ EDI, has had a new Editor-
in-Chief: Anita Wuttke. The experienced print journalist from Munich succeeds Ralf Suckert, who had been
responsible for EDI Journal as Editor-in-Chief since 2005.
On 1 April 2014, teamwork media GmbH became a
100% subsidiary of Deutscher Ärzte-Verlag. Dieter
Adolph continues as CEO. Following the departure
of Ralf and Angelika Suckert after 15 successful years
as Managing Partners of teamwork media GmbH,
there has been some restructuring at EDI Journal.
The Suckerts will continue to support teamwork
media in an advisory capacity, and Ralf Suckert will
remain Publisher of all teamwork journals. One
vacant position was that of Editor-in-Chief of EDI
Journal, which is published and edited by team-
work media, with BDIZ EDI as legally responsible
publisher.
Scientific Advisory Board
Dr Jörg Neugebauer, Chairman of the Qualification and
Registration (Q&R) Committee of BDIZ EDI, has been a
member of the Scientific Advisory Board of BDIZ EDI for
many years, which he will be chairing in the future. The
Scientific Advisory Board reviews the submitted papers.
It may require manuscript changes and improvements
where appropriate or reject submissions of insufficient
quality.
Anita Wuttke Dieter Adolph Ralf Suckert
In June this year, the BDIZ EDI Board unanimously
decided to appoint Anita Wuttke as Editor-in-Chief.
Wuttke, a journalist running a private media agency
in Munich, had already been Media and Public Re-
lations Consultant of the association since 2007.
From 2007, she served as Managing Editor for the
German-speaking BDIZ EDI konkret and the Eng-
lish-speaking EDI Journal.
The new Editor-in-Chief
Anita Wuttke has many years of experience as
a journalist. Her self-published “Bayern News”
health policy newsletter has appeared regularly
since 2006. Until 2005, she had been Managing
Editor of the Bavarian State Dental Association’s
journal, Bayerisches Zahnärzteblatt (BZB). Her
journalistic roots are in print publications. From
1998 to 2000, she was Chief Editor of the week-
ly Bad Kissinger Anzeiger, which appears in two
large counties in Northern Bavaria with a circula-
tion of 100,000 and where she led a 15-member
local editorial team. She is a journalist with a pas-
sion for research and for sharing her opinions. In
recent years, she has focused heavily on health-
care policy.
Angelika Suckert
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34
EDI NEWS

The team behind The team

EDI Journal: The teamwork media publishing team has also seen
(Left to right)
Christoph Csokas, some changes. Kerstin Jung is now Managing Editor
Sigrid Eisenlauer, of BDIZ EDI konkret, while Simone Stark is Managing
Kerstin Jung, Editor for the English-language EDI Journal. Simone
Simone Stark,
Marianne Steinbeck
Stark has many years of editorial experience. She has
and Anita Wuttke. been editor of EDI Journal since 2006 and has served
as Managing Editor for Bayerisches Zahnärzteblatt
(BZB) since 2007. Graphic designer Christoph Csokas
is now production leader; Sigrid Eisenlauer will con-
tinue as layouter of EDI Journal. The project man-
agement of the two journals will also remain where
it has successfully been for many years, in the hands
of Marianne Steinbeck (Miesbach).

Relaunch
At the same time, EDI Journal has undergone a re-
launch. Its cover and layout have been modernized.
Both in content and in design, the “new” EDI Journal
proves that print media do not have to look or feel
boring.
Dr Stefan Liepe
Managing Director, BDIZ EDI

European Consensus Papers online

Guidelines for download

There are currently nine Guidelines of the European Consensus Conference (EuCC) avail-
able for download from the BDIZ EDI website. The most recent consensus paper of 2014
deals with the avoidance of implant malpositioning.

Each year since 2006, the European Consensus Con-
ference has met under the auspices of BDIZ EDI to
address a current issue in oral implantology and to
develop a guideline for all European implantolo-
gists aimed at identifying and avoiding problems
in a timely manner and at managing any problems
that do arise.
2009: 3D imaging
2010: Managing surgical complications
2011: Short and angulated implants
2012: ABC Risk Score for implant treatment
2013: Cologne Classification of Alveolar Ridge
Defects (CCARD)
2014: Avoiding implant malpositioning

Overview of existing guidelines: The EuCC Guidelines of BDIZ EDI can be downloaded
2006: Immediate restoration and immediate from www.bdizedi.org > English > Professionals >
loading Guidelines.
2007: Ceramics
2008: Peri-implantitis AWU
 Die Zukunft
der Implantologie!

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36
EDI NEWS

Certification as an EDA Expert in Implantology

Qualification for
experienced implantologists
For many years, BDIZ EDI has been catering to experienced and well-versed oral implantologists by offering
the certification exam for EDA Expert in Implantology. Jointly with the European Dental Association (EDA),
BDIZ EDI regularly invites interested dentists to take the certification exam, which we would like to present
in this article.

That quality is of paramount importance to BDIZ

EDI is no secret. BDIZ EDI has demonstrated this in
many different areas – legal and accounting, mate-
rials testing, postgraduate education, the annual
Guidelines of the European Consensus Conference
(EuCC) on current implantological issues and finally
the qualification of court experts. BDIZ EDI also sup-
ports dental education with its Curriculum Implan-
tology that introduces aspiring dentists and young
implantologists to this dental specialty in eight
well-organized modules.
Admission requirements for the certification exam
Certification as Expert in Implantology requires very
good to excellent skills and knowledge. Candidates
must meet the following admission requirements:
• 250 EDA-recognized continuing education/training
hours in various sub-disciplines of implantology
• Submission of ten documented, independently
performed implantological treatment cases
• At least five years of professional activity, primarily
in the field of implantology
Specific experience and primary activity in the field
of implantology must be documented by at least
400 implants inserted and 150 implants restored
within the past five years. Candidates who already
obtained qualifications in oral implantology (e.g.
from other professional societies) may submit the
appropriate credentials with their application for
certification as EDA Expert in Implantology.
More information
If you would like to register for the next certification exam, you may
receive pertinent information and registration documents online at
www.bdizedi.org (select English > Professionals and click Education) or
by writing to the BDIZ EDI office in Bonn at office-bonn@bdizedi.org.
The exam
Candidates meeting all the requirements will be ad-
mitted to the examination. The examination board
of BDIZ EDI and EDA consists of recognized special-
ists. The exam has a theoretical and a practical part,
both of which must be completed successfully.
The procedure is as follows: The theoretical part
of the exam will start with a discussion of the docu-
mented cases. In addition, candidates are expected
to answer questions related to oral implantology and
closely associated fields. The theoretical examina-
tion usually takes no longer than 60 minutes; it
may be administered to candidates in groups. The
practical part of the examination covers one or
more recognized, state-of-the-art treatment method
or methods and/or treatment plans covering some
aspect of oral implantology. Candidates will be in-
formed of the respective topic two weeks before
the exam date. Candidates are responsible for pro-
viding the required materials and instruments on
the day of the exam. The examination as a whole
is subject to a fee to cover the cost incurred by the
examination board.
New EDA Experts in Implantology are nominated
by the president or vice president of the EDA certifi-
cation committee.
AWU
Applicant’s address:

European
Full name ____________________________________________________________________________
Association of
Dental
Full address ____________________________________________________________________________
Implantologists
____________________________________________________________________________

____________________________________________________________________________

E-mail ____________________________________________________________________________ Date _________________________

Forward by mail or fax to:

European Association of Dental Implantologists (BDIZ EDI)

An der Esche 2
53111 Bonn
Germany

office-bonn@bdizedi.org
Fax +49 228 93592-46

Certification exam: EDA Expert in Implantology

Application for accreditation
I hereby apply for the EDA Expert in Implantology certification exam (EDA = European Dental Association).
I am qualified for this exam as defined below:
Member of BDIZ EDI yes no
Member of the following Societies/Associations: _______________________________________________________________________________
I am: a dental clinician an oral surgeon a maxillofacial surgeon
I meet the training requirement of 250 hours of postgraduate education. yes no

Education and experience:

Surgery:
Inserted implants: less than 400 more than 400
Sinus lift: yes no
Close to nerve: yes no
Advanced atrophy of the jaw: yes no
Soft-tissue augmentation: yes no
Bone augmentation: yes no

Prosthodontics:
Implant-supported restorations: less than 150 150 or more
During the exam, I will be able to present documentation for 10 treatment cases. yes no

I understand that the examination board will review my qualifications and vote to accept or reject my application. Furthermore, I declare that all
images I present are my own and that the implants have been inserted and prosthetically restored by me.

_________________________________________________________________________________ __________________________________
Applicant’s signature Date

Having successfully passed the exam and paid the requisite fee, I will be certified as EDA Expert in Implantology.
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40
EDI NEWS
Taking leave of Veronika Rehers-Bender
A strong and competent companion
For decades dentists had
known her pleasant voice,
admired her eloquence and
paid tribute to her profes-
sional conference interpre-
tation skills from or into
English – even under the
most difficult conditions.
Veronika Rehers-Bender was
a simultaneous interpreter
in a class by herself, always
in charge of the situation,
always leaving a lasting im-
pression. Now her voice will
be silent forever. Veronika
Rehers-Bender died in Munich
Veronika Rehers-Bender †
on 9 July 2014 after a severe
and protracted illness.
Born on 1 September 1946 in Neuenhaus, Ger-
many, near the Dutch border, she grew up in nearby
Nordhorn. After graduating from high school, she
studied English and Spanish at the Language and
Interpreting Institute (SDI) in Munich, where she
graduated in 1972 after passing the state examina-
tions for interpreters and translators and for confer-
ence interpreters.
She worked and completed her studies in the
United States and Spain before taking the step into
self-employment. As a conference interpreter, she
soon became increasingly specialized in medicine
and dentistry. Her first dental “missions” were the
interpretations of courses held by Bob Lee for the
Dental Working Group Kempten. From the begin-
ning, she distinguished herself by her competent
use of dental terms and by her ability to lucidly in-
terpret the discussions between the speakers and
their audience.
Since 1990, she had organized international
teams of interpreters for scientific organizations
and enterprises from medicine and dentistry. To-
gether with her colleague and business partner
Martha Bohus, she had founded the network Con-
ference Consulting, Interpreting and Translations,
which rapidly made a name for itself internation-
ally and excelled in its professionalism, the diversity
of languages covered and the high level of compe-
tence of the interpreters they sent out.
But what few people knew: Veronika Rehers-
Bender was also a sought-after interpreter for vari-
ous television stations and lent many celebrities
her voice – including Bill Gates, Britney Spears and
Tina Turner.
Veronika Rehers-Bender was highly professional,
and not only in her work. She was a warm-hearted
woman with a genuine interest in the people she
met and with whom she worked. But her own life
was anything but easy. Together with her husband,
she was for many years the devoted caretaker of her
seriously ill brother.
And through the many years of her own illness
and numerous health setbacks, she still succeeded,
again and again, in harnessing her optimism and
strong will to find her way back to normality, assist-
ed by the iron self-discipline that held her up in her
private as well as in professional life. On 9 July 2014,
she passed away in her adopted home town, Mu-
nich. The BDIZ EDI board and the many members
who knew her are mourning a strong and warm-
hearted traveling companion. Dear Veronica, we will
miss you!
Christian Berger
on behalf of the BDIZ EDI Board
BTI ABUTMENTS
THE EXCELLENT HERMETIC SEAL
· Maintain the flexibility of two-piece implant system.
· Implant and abutment complex behaves biomechanically as one piece.
· Mitigate the risk of bacterial invasion.
· Improvement of aesthetic appearance.
· Surface treatment to improve adhesion to the soft tissues.

AESTHETIC
ABUTMENT BIOPILAR
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HERMETISM SEAL
SCANNING
ELECTRON MICRO-SCALE ANALYSIS SHOWS THE
MICROSCOPY
ACHIEVEMENT OF HERMETIC SEAL
AT IMPLANT-ABUTMENT INTERFACE

REFERENCES
· Anitua E, Alkhraist MH, Piñas L, Begoña L, Orive G. Int J Oral Maxillofac Implants. 2014;29:682-9.
· Anitua E, Alkhraisat MH, Miguel-Sánchez A, Orive G. J Oral Maxillofac Surg. 2014;72:683-93.
· Anitua E, Alkhraisat MH, Orive G. Int J Oral Maxillofac Implants. 2013 Sep-Oct;28(5):1338-46.
· Anitua E, Alkhraisat MH, Murias Freijo A, Orive G. 23rd Annual scientific meeting of EAO, 25-27 September 2014, Rome, Italy.

For further information,

please scan the QR code with
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www.bti-biotechnologyinstitute.com
export@bti-implant.es
 42
+++
+++
+ euro
europe
europ
eur
eu
europ
EDI NEWS
Europe Ticker +++
Majority EP vote for the candidate
from Luxembourg
Juncker is President of the
Photo: © European Union, 2014
Commission
Jean-Claude Juncker of Luxembourg has been con-
firmed as President of the European Commission.
After weeks of haggling over his nomination and at-
Jean-Claude Juncker tacks from Britain, Juncker has reached his goal: He
received 422 votes; 376 would have been enough.
There were 250 votes against. “Europe needs a
broad agenda for reform”, said the 59-year-old
Christian Democrat as he spoke in the plenary of
the European Parliament. “People are often afraid
of reforms. But those who risk nothing run the
greatest risks.” His vision is for an EU that takes a
back seat – assisted, for example, by a commissioner
for eliminating bureaucracy and a more stringent-
ly organized commission. Currently, each of the
28 member states may appoint one commissioner,
each of whose votes carries the same weight. There
are discussions to name eight “top commission-
ers” who coordinate issues such as energy, trade or
economic policy. However, this is not to the liking of
the smaller member states, who would presumably
have to stand second in line. The limits of Juncker’s
actual influence become evident when looking at
the fact that he wants as many female commis-
sioners as possible – but the member states have
nominated almost no female candidates.
Source: Spiegel Online, Germany
OECD study
Lower health spending
across the EU
The financial crisis has resulted in declining health
spending in many Euro countries. In Germany, by
contrast, expenditures rose about one per cent each
during 2012 and 2013. By contrast, health spending
in 2012 fell in Greece, Italy, Portugal, Spain, the Czech
Republic and Hungary, as reported by the OECD. In
Greece, they had dropped as much as 25 per cent
below their 2009 level.
Outside Europe, healthcare expenditures were
often up considerably. In Chile they increased by
6.5 per cent in 2012, and 8.5 per cent in Mexico. In
South Korea, the growth rate, at six per cent per
year, has been unchanged since 2009. The United
States recorded a growth in health spending by
2.1 per cent in 2012. The 34-country OECD average
was approximately 1.8 per cent. The U.S. had by far
the most expensive healthcare sector at 16.9 per
cent of its gross domestic product (GDP). In terms of
GDP share, Germany comes fifth in the OECD rank-
ing, at 11.3 per cent, trailing the Netherlands (11.8 per
cent), France (11.6) and Switzerland (11.4).
Source: Deutsche Ärzte-Zeitung, Germany
ECJ legal expert
Treatment abroad at risk
If EU citizens receive medical treatment abroad be-
cause it is not available at home, their health insur-
er must pay. But now this rule may be relaxed. In the
dispute over the treatment of citizens from poorer
Eastern European member states, a compromise
proposed by the legal expert of the European Court
of Justice (ECJ) in Luxembourg, Pedro Cruz Villalón,
intends to protect welfare coffers in the countries
of origin. These countries should pay for treatment
abroad only if this treatment cannot be offered
domestically because of a “selective shortage” of
resources. By contrast, the countries in question
should not have to pay for treatments whose cost
would simply overwhelm the respective countries’
social-security systems.
Since the accession of Romania and Bulgaria to
the EU in 2007, patients, especially from Romania,
try to escape the, sometimes precarious, healthcare
situation in their home country by seeking treatment
in Germany. According to the closing arguments
by ECJ Advocate General Cruz Villalón, hospitals in
Germany should brace themselves for only limited
reimbursement by the countries of origin. The ECJ
will not announce its final judgement until a few
months from now. While closing arguments are not
binding on the ECJ, it does tend to follow them.
According to previous ECJ case law, EU citizens
can seek treatment in a different member state if a
treatment is available in their home country in prin-
ciple but cannot be provided there in time. Now, for
the first time, the top EU court will have to decide
44
+++
+++
+ euro
europe
europ
eur
eu
europ
EDI NEWS
Europe Ticker +++
what is to be done if funds are completely lacking.
Cruz Villalón is convinced that the Eastern European
member states should not have to face any costs
that they essentially cannot bear. They should only
be obliged to pay in the case of “a selective and
temporary shortage”, but not if a lack of medical
resources “constitutes a structural deficiency”. Here,
the Advocate General believes that an obligation to
assume the costs exists only if this does not com-
promise the functioning of the healthcare system
of the respective country – which would probably
be the case only in very rare diseases. If countries
were expected to shoulder “the financial burden of
massive health migration”, this could consume all
of the available funds for the healthcare sector in
the respective country, causing further deteriora-
tion of the situation, according to Cruz Villalón.
The Romanian courts will have to decide the par-
ticular case on hand based on these provisos. (Clos-
ing arguments before the ECJ, 19 June 2014, case
C-268/13.)
Source: Various media
The new president ... is the old president
Schulz re-elected
EP President
Martin Schulz, a Social Democrat from Germany,
has been re-elected President of the European Par-
liament. In late July, at the inaugural meeting of the
new European Parliament in Strasbourg, Schulz re-
Martin Schulz
in conversation
with Germany’s
Chancellor
Angela Merkel.
Photo: © European Union, 2014
ceived 387 of the 670 valid votes. The required abso-
lute majority was 336 votes. Schulz is the first presi-
dent of the European Parliament to be re-elected
for a second term, which will last for two and a half
years. According to an agreement between the
two largest groups in the EP, Schulz, who will then
be 58 years old, will then be replaced by a represen-
tative of the Conservatives.
Source: Various media/Deutsche Welle, Germany
Changeover in the EU Council presidency
Italy to focus
on healthcare policy
It has been Italy’s turn to hold the EU presidency
since the beginning of July. The country wants to
achieve closer cooperation in healthcare policy. The
Italian presidency wants to emphasize the role of
healthcare policy on the European agenda during
its six-month term, not least because of the many
cross-border aspects of the topic.
Beatrice Lorenzin, the Italian health minister, par-
ticularly mentioned health research at a high pri-
ority. Specifically, the Italian presidency intends to
focus on HIV/AIDS research, vaccine development,
research on age-related diseases such as dementia
and Alzheimer’s as well as pain research and pal-
liative care, all under the 3rd EU Health Programme
(2014–2020).
Patient safety and efficient and economic aware-
ness in public healthcare will be a special focus.
In the past, reports of poor quality and untenable
hygienic conditions in public hospitals in Italy had
alarmed the public. Italy therefore wants to go for-
ward with the controversial revision of the EU Medi-
cal Devices Directive at the European level. Similarly,
the European health insurance systems should be
put to the test.
During their presidency, the Italians also want to
stimulate an intense discussion about patient safe-
ty and to minimize the spread of infectious diseases
through a cross-border exchange of best-practice
models. At the EU Council of Health Ministers
on 22 and 23 September in Milan, the interplay of
medical research, the pharmaceutical industry and
clinical research were on the agenda.
Source: Deutsche Ärzte-Zeitung, Germany
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46
EUROPEAN LAW
ECJ: “Legal highs” are
not medicinal products
The European Court of Justice (ECJ), in its judgement of 7 July 2014 (cases C-308/13, C-171/14), has ruled that
the so-called “legal highs” are not medicinal products. Trade in these intoxicating herbal blends that contain
synthetic cannabinoids or amphetamine-like substances – and are often sold as room fresheners, bath salts
or even plant food – therefore cannot be prohibited pursuant to the German law on medicinal drugs
(Arzneimittelgesetz, AMG).
Consumption of these synthetic can-
nabinoids, which are often smoked as
cannabis substitutes, generally induces
a state of intoxication, which can go
from intense elation to hallucinations.
Possible reactions also include nausea,
palpitations, delusions and cardiac ar-
rest. The pharmaceutical industry had
already tested the synthetic canna-
binoids in pre-experimental studies.
The hoped-for positive health effects
could not, however, be demonstrated.
Instead, it was found that the psycho-
active effects of these compounds are
associated with significant adverse
reactions, whereupon testing was dis-
continued.
The case
Two sellers of these herbal mixtures were
sentenced by German criminal courts to
imprisonment for violating the German
Drug Law. At the time of the main pro-
ceedings, the “legal highs” mentioned
were not covered by the German law
on narcotic drugs (Betäubungsmittelge-
setz, BtMG). They were, however, classed
as unsafe medicinal products pursuant
to the AMG on account of their harmful
pharmacological effects and their ad-
verse effects on health.
Accordingly, the German courts con-
cluded that the sellers were guilty of in-
tentionally marketing unsafe medicinal
products pursuant to Article 95(1)(1) of
the AMG and sentenced the sellers. The
sellers appealed to the German Federal
Court (Bundesgerichtshof, BGH).
The BGH recognized that its deci-
sion regarding the criminal liability of
the sellers would significantly depend
on whether the “legal highs” sold may
be classified as medicinal products.
The term “medicinal products” is de-
fined in Article 2(1) of the AMG, which
states that medicinal products are sub-
stances or a combination of substances
“which may be used in or administered
to human beings either with a view
to restoring, correcting or modifying
physiological functions by exerting
a pharmacological, immunological or
metabolic action, or to making a medi-
cal diagnosis”.
Section 2(1) of the AMG transposes
Article 1(2) of Directive 2001/83/EC into
German law. The Federal Court of Jus-
tice decided to stay the proceedings
and to refer to the ECJ for a preliminary
ruling on the question whether the
products sold may be classified as me-
dicinal products within the meaning of
Article 1(2)(b) of Directive 2001/83/EC.
Specifically, the Federal Court of Jus-
tice wanted to know whether the defi-
nition of medicinal product includes
substances that merely modify physi-
ological functions but have no posi-
tive effects and are, at the same time,
consumed solely for their intoxicating
effect.
The judgement
The ECJ decided that the so-called “legal
highs” cannot be classified as medicinal
products under EU law.
§
According to its meaning in everyday
language, the word “modify” in itself
is neutral in terms of whether the ef-
fects produced are beneficial or harm-
ful. However, in interpreting a provision,
it is necessary to consider not only its
literal wording but also the context in
which it occurs and the objectives pur-
sued by the legislator in passing the
provision. In that regard, it should be
noted that EU law generally implies a
beneficial effect for human health and
that Article 1(2)(a) of Directive 2001/83/
EC specifically refers to “properties for
treating or preventing disease in hu-
man beings”.
The expressions “restore” and “correct”
in Article 1(2)(b) of Directive 2001/83/EC
should be understood as reflecting the
legislature’s intention to highlight the
beneficial effects of the substances on
the human organism. To avoid contra-
dictory interpretations, the expression
“modify” must also be interpreted as
encompassing only substances capable
of having a beneficial effect on human
health.
The term “medicinal product” must
therefore not be interpreted as cover-
ing substances whose effects – as in
this case – simply modify physiological
functions without any beneficial effects
for human health. Nor can the fact be
neglected that the substances at issue
are consumed not for therapeutic but
purely for intoxicating or recreational
purposes and that they are, in addition,
harmful to human health.

Assessment
The ECJ ruling is legally consistent, albeit
regrettable in fact.
The Supreme Court will have to can-
cel the sentences against the two sellers
of “legal highs”. In its decision, the ECJ
was of course aware that it was exempt-
ing the distribution of the substances
at issue in Germany from prosecution,
at least for any dates before 2009. But
the ECJ rightly determines, and explicitly
points out, that this fact cannot call its
conclusion into question.
Meanwhile, the selling of “legal highs”
may constitute a criminal offense pur-
suant to the BtMG. Since 2009, Ger-
man legislators have included a total of
56 new substances in the BtMG – includ-
ing psychoactive substances contained
in “legal highs”. Several synthetic canna-
binoids of the JWH group, the amphet-
amine derivatives fluoroamphetamine
and 4-fluoroamphetamine, as well as
the cathinone derivatives flephedrone
and methedrone, are now classified as
narcotics pursuant to the BtMG.
However, new psychoactive substanc-
es continue to be developed by altering
the chemical structure of the synthetic
cannabinoids. These substances, which
are (still) not covered by the BtMG, are
subsequently marketed. Only those
substances explicitly mentioned in the
law are prohibited. If the BtMG is to be
applied in a specific case, a legal race
arises between producers, often resid-
ing in Asia, and German legislators, and
the producers always appear to be one
47
EUROPEAN LAW
step ahead. This implies continued incal-
culable risks to consumers, as the exact
compositions and interactions of the in-
gredients usually remain unknown. Sev-
eral deaths have already been reported
in Germany.
One possible measure would be to
adapt the BtMG in the same manner as
already practiced in Austria and in Swit-
zerland. There, not individual substanc-
es, but entire groups of substances were
included in the pertinent narcotics laws.
It remains to be seen whether the Ger-
man legislators will proceed in the same
manner.
Contact address
Solicitor Nico Gottwald
Ratajczak & Partners
Berlin · Essen · Freiburg · Jena ·
Meissen · Munich · Sindelfingen
Posener Strasse 1
71065 Sindelfingen
Germany
48
CLINICAL SCIENCE

Technological change in implantological diagnostics

From X-ray film to digital radiology

DR JÖRG NEUGEBAUER1,2, DR FRANK KISTLER1, DR STEFFEN KISTLER1, DR MARTIN SCHEER3

Over the past 25 years, implant therapy has evolved from a specialist treatment mode for a few experts to
a routine treatment option that many dentists provide. The decision for or against implant treatment and
any related augmentation procedures requires a detailed radiological diagnosis, the exact nature of which
will have to be determined depending on body regions and prevailing anatomical conditions. In the early
years of oral implantology, the only available options were panoramic radiographs (orthopantomographs,
OPG) and standard dental X-rays film, and the radiation doses required at the time were high. Yet the appli-
cation of today’s digital 3D diagnostics – despite relatively low radiation exposure – has been viewed criti-
cally in line with the technology becoming more widespread, for reasons of radiation hygiene [19]. There-
fore, depending on the clinical findings and planned therapy, the radiological technology to use should be
chosen to yield a maximum of pertinent information with minimum radiation exposure [1]. The digitization
of dental radiology makes radiological data immediately available anywhere in the dental practice. In ad-
dition, it provides effective ways of exchanging data with referrers and even allows joint case discussions
with specialists over the internet.

Justifying indication Imaging technology

In principle, taking a radiograph requires a justify- In addition to the classic X-ray films requiring wet
ing indication that meets the requirements of the chemical development, two digital technologies
guidelines in effect and that shows that the ben- have now become established in the dentist’s of-
efit for the patient is greater than the risk of dam- fice: indirect imaging plates and direct digital sen-
age caused by ionizing radiation [1]. In dentistry, sors [2]. Indirect digital imaging plates are similar to
1
Dr Bayer, Dr Kistler only two guidelines currently exist in Germany that traditional X-ray films, using thin sheets that can be
and Dr Elbertzhagen,
are associated with radiological diagnostics [7,16]. adapted to the limited available space even in a nar-
Private Practice,
Landsberg am While their realm is three-dimensional diagnostics row anatomic situation. One disadvantage of these
Lech, Germany and the application of navigated implant placement, imaging plates is the mechanical stress caused by
2
Interdisciplinary a number of principles listed there can be equally scratches and creases, so that the imaging plates
Clinic for Oral
Surgery and applied to conventional radiological diagnostics. have to be replaced after a certain period of use,
Implantology, Since a cone-beam computed technology (CBCT) as the diagnostic performance will be gradually
Department of image is usually associated with two to five times reduced [4] (Fig. 1). Another disadvantage are the
Dentistry and Oral
the radiation exposure of a conventional dental additional and time-consuming steps required for
and Maxillofacial
Surgery of the X-ray, a preliminary diagnosis based on, for exam- electronic “development” to make the image digi-
University of ple, existing radiographs and/or a clinical exami- tally available on the screen at chairside.
Cologne, Cologne,
nation is required to determine whether a CBCT is Newer generations of intraoral sensor types ex-
Germany
3
Oral and Maxillo- strictly indicated. When sufficient information for hibit a real resolution that corresponds to 16 or even
facial Surgery, the prospective treatment can be obtained by a tra- 28 line pairs per millimetre. These modern intraoral
Mühlenkreis- ditional two-dimensional X-ray, the latter should be sensors achieve thus an image quality that match-
kliniken, Johannes
Wesling Klinikum sufficient. Hence, a CBCT recording is not routinely es the quality produced by X-ray film. This high reso-
Minden, Minden, indicated for a wide alveolar ridge with no apparent lution, which by far exceeds that of imaging plates,
Germany need for augmentation. is owed to scintillator material based on caesium
 49
CLINICAL SCIENCE

1 I Follow-up control radiograph of an
implant with significant artefacts due
to wear on the scanner’s imaging plate
(Digora; Soredex, Tuusula, Finland).
2 I Traditional dental X-ray film showing
a finely textured image of the trabecular
bone in a pronounced vertical bone defect
at implant 24.
3 I Postoperative control radiograph after
reconstructive peri-implantitis treatment
with autologous bone chips. Blurred repre-
sentation of the local bone (imaging plate;
Soredex).

4 I Follow-up control radiograph after three months showing a finely 5 I A single digital image is taken with a WiFi sensor (Xios XG Supreme
textured image of the trabecular bone and secondary caries on the Sensor with WiFi; Sirona).
endodontically treated tooth 27 (Xios XG Supreme; Sirona, Bensheim,
Germany).

iodide, whose crystalline structure generates less
X-ray scatter and achieves a higher quantum ef-
ficiency [3]. Their high-resolution intraoral sensors
allow a simpler and therefore more reliable diag-
nostic assessment (Figs. 2 to 4) especially in cases
where a high level of detail is required – peri-im-
plant diagnostics, secondary caries, endodontic or
periodontal issues.
The sensors provide immediate availability with-
out time delay – even intraoperatively – as the re-
corded digital image appears immediately on the
screen. A disadvantage here is the required direct
connection to a computer, which requires special
technical equipment depending on the setup of
the operating room. The image itself is usually taken
with a wired sensor connected via a LAN or USB
port. A new, very convenient approach is data trans-
fer by a WiFi module, as this eliminates the need
for a direct cable connection in the sterile field. The
short sensor cable simplifies routine dental use, as
there is no longer a need to step over or even a risk
of tripping over the cable (Fig. 5). Once set up, the
sensor remains in place; nothing can slip, and extra
images are avoided. This also makes it unnecessary
to run LAN cables into each treatment room, which
facilitates the integration of digital radiography. As
the images are available digitally, small tablets run-
ning special apps that can access the database with
the X-ray images can be used for patient education.
Intraoral imaging
When taking intraoral X-ray images, only a short
burst of radiation is generated, and the attenua-
tion of the X-rays is recorded on film or by sensor
(summation recording). The area recorded can be
2 x 3 cm or 3 x 4 cm in size, depending on the selected
50
CLINICAL SCIENCE
6 I Monitoring of an implant-prosthetic treatment over several years, with unclear represen-
tation of bone levels in the anterior maxilla.
detector. Thus, the available bone can be assessed on
dental film even after augmentation, e.g. in the case
of a single-tooth gap. Dental film is also well suited
for the postoperative control of single implants,
particularly in the anterior maxilla and mandible,
because there are no overlays of the spine as in an
OPG, allowing an accurate representation of the
crestal bone (Figs. 6 and 7).
When using traditional dental film, the diagnostic
significance can be reduced by two factors, usually
caused by the incorrect positioning of the film and
X-ray tube relative to the patient. Merely having the
8 I
Comparative
presentation of
dental films, from
implant insertion to
restoration delivery
(Sidexis; Sirona).
7 I Detail image showing peri-implant bone
loss.
patient hold the film, e.g. when using the bisecting
angle technique, results in a relatively large error, as
the film easily slips during recording. Another diag-
nostic source of error with film or imaging plates is
the strong deformation, especially in the maxillary
canine region. The supposed advantage of adapta-
tion to the anatomical situation soon becomes a di-
agnostic disadvantage when clinical crowns or roots
are shown distorted. Moreover, the bisecting angle
technique requires a lot of experience in order to ob-
tain undistorted images. Here the paralleling tech-
nique yields more accurate metrics than the bisect-

9 I Control OPG with an insert superimposed on the
right mandible to reduce radiation exposure (Orthophos
XG3D; Sirona).
ing angle technique [17]. Using a holder system for
the paralleling technique allows secure positioning,
so that a dimensionally accurate record is obtained.
But despite all precautions, deviations or distortions
may still occur. When performing length measure-
ments for implant treatment planning, these should
be backed up by an earlier OPG or CBCT.
In general, all three technologies require ad-
equate operator training to prevent unnecessary
repeat images and to spare the patient the pain
caused by an inappropriately positioned image re-
ceptor [20].
Implant treatment is a long-term treatment that
requires an appropriate follow-up schedule to as-
sess the individual risk of peri-implantitis. Therefore,
in addition to the baseline diagnostics for planning
the surgical procedure, documenting the results
of the prosthetic treatment is also important; this
documentation should be available for consultation
during all subsequent treatment sessions. Dental
film still offers the highest information density for
assessing the crestal bone levels around individual
implants. Digital archiving allows comparisons of
multiple images on one screen, e.g. to assess the
development of peri-implant bone levels (Fig. 8).
Orthopantomography
An orthopantomogram (OPG) is a panoramic radio-
graphic image obtained by letting an X-ray source
move on a specific parabolic path, a process that
usually takes 9 to 14 seconds. The result is a tomo-
gram of a layer about 2 cm thick along the man-
dibular arch that represents the relevant structures
of the entire jaw. OPGs render implant treatment
planning more accurate and at the same time less
complicated. Errors when recording an OPG are
rare, since the correct positioning in the X-ray can
51
CLINICAL SCIENCE
10 I Insufficient regenerated alveolar ridge twelve weeks after tooth extraction.
be readily achieved when the appropriate guiding
lines are displayed. Individual variations in mag-
nification factors may still occur, but these can be
compensated for by including a calibration sphere.
A simple conversion factor can be used to obtain
precise metrics for an analysis that is sufficiently
accurate in the vertical dimension to facilitate im-
plant placement. The size of the image acquisition
window can be digitally controlled, which means
that one-half or one-quarter OPGs can be obtained,
which is often sufficient for implantological pur-
poses and keeps the radiation exposure low (Fig. 9).
In difficult situations with undercut areas in the
lower jaw, a reduced apical base in the maxilla, in-
sufficient regenerated extraction sockets and related
atrophy, diffuse structures in the maxillary sinus
or if the patient reports sinus-related complaints, a
CBCT can be indicated [7] (Fig. 10).
Cone-beam computed tomography
The introduction of cone-beam computed tomo-
graphy (CBCT) about ten years ago has signifi-
cantly extended the oral implantologist’s range
of diagnostic and therapeutic options [10]. To ob-
tain a CBCT image, an X-ray source and sensor are
guided around the facial scull on a circular path.
As a rule, between 100 and 400 imaging layers are
generated and digitally processed. The raw imaging
data can be converted to classical tomographic im-
ages (as known from computed tomography) or to
panoramic curves with corresponding sagittal and
transverse sections (which are familiar to dentists)
using appropriate algorithms. The most important
diagnostic limitations of CBCT are movement- or
metal-related artefacts that can make accurate
metrics or the assessment of thin tapered bone
structures impossible [21].
52
CLINICAL SCIENCE

11 I Importing the virtual planning data generated by an optical 12 I Placing markers on the teeth in the CAD/CAM model and in the
impression (Cerec; Sirona) into the planning software. 3D data set.

13 I Validating the superimposition of the surface model in the CBCT 14 I Digitally designed prosthetic proposal superimposed on the
data. situation by the planning software (Galileos Implant; Sicat, Bonn,
Germany).

plement the implant planning, surgical guides can

be produced within the software of the respective
system itself, or the data can be exported in DICOM
format [5]. A reference structure must be positioned
in the patient’s mouth during recording so that the
corresponding data can be read in by the planning
software.

CAD/CAM surgical guides

15 I Final implant planning with implants aligned according to the
digitally designed prosthetic proposal.
3D surgical guides
CBCT can assist not only precise preoperative plan-
ning but can also be used to prepare a 3D surgical
guide for implant placement. For this purpose, a
simulation of the desired prosthetic result in the
form of a barium-sulphate-doped wax-up must be
in place at the time of image acquisition [12]. To im-
For the production of accurate surgical guides, the
low resolution offered by CBCT can be compensated
for by superimposing optical impression data [18].
In this way, the visualization of the desired pros-
thetic result can be effected by digital modulation
based on the data generated in a standard CAD/
CAM design programme. Once the digital wax-up
has been exported, the data are read into the 3D im-
plant planning software and superimposed on the
existing data (Figs. 11 to 14). The planning software
is then used to determine the prosthetically driven
implant position and to design the surgical guide
using different sleeve systems (Fig. 15).
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16 I Web-based communication platform to track the processing
status and to exchange data with referring physicians/dentists
(Sicat portal; Sicat).
SCREEN, HANDPIECE WITH
SWIVEL-TYPE LED LIGHT
mectron s.p.a., via Loreto 15/A, 16042 Carasco (Ge)
Italia, tel +39 0185 35361, fax +39 0185 351374
mectron@mectron.com, www.mectron.com

17 I Protected area for communication with the partners or experts

involved in the production process.

The application of 3D surgical guides requires ex-

tensive training. The results obtained will depend
on the individual’s learning curve [5]. As a result,
there have been developments in the service sector,
where dentists who rarely perform implant treat-
ment communicate the CBCT data, core surgical as-
pects such as planned augmentations or favourite
implant systems and information on the envisaged
restoration. Based on these data, a planning propos-
al is created in the form of a surgical guide for subse-
quent approval by the surgeon (Figs. 16 and 17). Dis-
cussing the treatment plan in a network of experts
helps avoid errors in planning and implementation
[16]. This type of “remote dentistry” allows digital
planning as well as online interaction between den-
tal experts and treatment providers, which provides
more safety and relieves the dentist of working
with the implant planning software [20].
By superimposing the digital wax-up, a CAD/
CAM-produced surgical guide can be milled directly
after the design data have been received. This is no
longer based on surface X-ray data but directly on
54
CLINICAL SCIENCE

18 I Implant site preparation with the pilot drill using the CAD/CAM 19 I Implant insertion using the Optiguide surgical guide with lateral
surgical guide (Optiguide; Sicat). augmentation using autologous material (Xive; Dentsply Implants,
Mölndal, Sweden).

20 I Using the surgical guide at re-entry to locate the implants. 21 I Checking the positions of the healing abutments at re-entry
with the help of the surgical guide.

the superimposed optical impression. This ensures
a much better fit and improves the accuracy of
the overall process chain [11]. The digital design ap-
proach also simplifies the logistics of the case, as
the need for sending models with reference plates
or barium-sulphate-doped set-ups by courier is
eliminated (Figs. 18 to 24b).
Discussion
The implant workflow has been optimized in the
past 25 years through various developments in the
field of digital radiology, especially when it comes to
larger practices or practices with a high proportion
of referrals. Digital images can be copied freely and
rarely exhibit quality problems. If the referring clinic
uses the same software, the data can be transmit-
ted back there for permanently storage [2]. Digital
radiological images make it easier to evaluate the
patient’s progress at implantological follow-ups.
Each image is clearly associated with a specific date
and can be displayed on a screen. The reduction
of radiation exposure as propagated in the early
years of the technology is no longer considered a
relevant argument in favour of its application, since
high-resolution sensors require comparably low ra-
diation doses and traditional dental films exhibit a
higher sensitivity at similar film quality (F-Speed).
As a result, radiation doses as required formerly are
no longer necessary today [8].
As CBCT is becoming more widespread, there
have been fears of its inflationary use in dentistry,
similar to what happened with CT scans in general
medicine [7]. However, it should be remembered
that a CBCT examines a much smaller area of the
body than a CT, where significantly higher radia-
tion levels would be necessary to obtain the same
resolution [9]. Any radiological examination re-
quires a justifying indication showing a diagnostic
or therapeutic benefit that exceeds the radiation
risk. One of the first guidelines in dentistry there-
fore addresses this very issue. This guideline was
drawn up by a consensus group of representatives
of several scientific associations; it has since been
updated [7].

22 I Checking the situation one year after delivery after the fixed
bridge had been temporarily taken out for oral hygiene.
24a and b I Radiological control of peri-implant bone levels one year after delivery of the restoration.
In 3D diagnostics, detailed information can be ob-
tained for the relevant findings. This gives the op-
erator accurate spatial data with a view to reducing
the risk of injury to sensitive structures [13]. A very
strict indication, as had been necessary with CT, is
not required for surgery in the immediate vicinity
of nerves, as CBCT units produce only low radiation
doses [9].
In the context of implant therapy, it has been
shown that guided implant placement can achieve
higher accuracy than free-handed drilling [15].
However, it is necessary to carefully weight the
cost against the potential benefits; not every den-
tal implant requires a surgical guide, especially in
the presence of a sufficient bone supply and if the
risk of damage to adjacent structures is low [14]. On
the other hand, the experience of recent years has
shown that the use of CBCT can shorten the dura-
tion of surgical interventions, potentially reducing
the postoperative trauma to the patient if a strict
indication for surgical guides exists [6]. The use of
radiological units with small imaging volumes – on
55
CLINICAL SCIENCE
23 I Definitive bridge. Stable soft-tissue conditions one year after
prosthetic delivery.
the order of 3 x 5 cm – in oral implantology should,
however, be viewed critically, as these are actually
designed for use in e.g. endodontics. These units
are not suitable for a complete diagnosis of the
skull, because several images would be necessary,
and the total radiation dose would be much higher
than when using devices designed for larger imag-
ing volumes.
To find the list of references visit the web (www.teamwork-media.de).
Follow the link “Literaturverzeichnis” in the left sidebar.
Contact address
Dr Jörg Neugebauer, PhD
Dr Bayer, Dr Kistler and Dr Elbertzhagen
Private Practice, Landsberg am Lech
Von-Kühlmann-Straße 1
86899 Landsberg am Lech
Germany
neugebauer@implantate-landsberg.de
www.implantate-landsberg.de
 © MIS Corporation. All rights reserved.

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58
CASE STUDIES

Current aspects in the treatment of periodontally diseased patients with angulated implants

Treatment of patients
with chronic periodontal disease
DR JÖRG NEUGEBAUER1,3 , STEFAN ADLER2, DR FRANK KISTLER1, DR STEFFEN KISTLER1

Implant treatment on patients with chronic periodontal disease is still viewed with scepticism by some
dentists. In addition to the presence of chronic inflammation parameters on the natural periodontal
system, the risk of early implant failure and of biological complications is viewed critically [23]. Although
we have reports covering many years of experience with implant treatment in periodontally compromised
patients, the relevant treatment concepts are still highly divergent, or the patient is denied implant therapy
due to this relative contraindication [21]. The incidence of periodontal disease has increased steadily in
recent years. Surgical and prosthetic treatment planning must be supplemented by the management of
the periodontal tissues before and during implant treatment as well as at recall in order to ensure long-
term success [11].

Microbiological load regeneration by its photobiological effect and ad-

An aggressive microbiological environment may
lead to peri-implantitis with acute inflammation
requiring invasive forms of treatment that may
even include explantation, depending on the stage
of the disease.
In classical periodontal therapy, supportive sys-
temic or local antibiotic therapy is generally rec-
ommended, but this requires a strict indication
because of possible systemic side effects, which
specifically include the development of hypersen-
sitivity and resistance even at lower dosage levels.
1
Dr Bayer, Dr Kistler Various alternative methods have been pre-
and Dr Elbertzhagen,
sented in recent years that follow a photodynamic
Private Practice,
Landsberg am or photothermal approach. Unfortunately, these
Lech, Germany treatments were not always effectively evaluated
2
Implant Dental scientifically before their launch, so only selected
Consult, Landsberg
am Lech, Germany methods can be justified for clinical use [7,8]. Anti-
3
Interdisciplinary microbial photodynamic therapy (aPDT) is a sys-
Clinic for Oral tem that has now been scientifically documented
Surgery and
for periodontal use. In aPDT, a highly concentrated,
Implantology,
Department of sterile dye is activated according to the wavelength
Dentistry and Oral of the photosensitizer, using low-level energy for a
and Maxillofacial
sufficient time period [4,5,20,24]. This reduces the
Surgery of the Uni-
versity of Cologne, pathogen spectrum and facilitates a physiological
Germany recolonization. The low-level laser supports tissue
ditionally helps stabilize the periodontal situation
(Figs. 1 to 4).
Implant-prosthetic treatment planning
Using a reduced number of implants by definition
reduces the peri-implantitis risk, as the restoration
will be supported by fewer implants [28]. Here we
can refer to the Brånemark group’s many decades
of experience with full-arch restorations, where the
entire dentition in a jaw is replaced by a single super-
structure [12].
A combination of immediate restoration and
immediate implant placement when removing
the last periodontally compromised teeth may
facilitate an effective fixed provisional restoration,
where the patient does not have to suffer an emo-
tionally stressful phase wearing a removable dental
prosthesis [2].
Depending on the existing bone supply and the
need for additional augmentation, immediate res-
toration is not always mandatory. Especially if exist-
ing teeth or implants can be used as supporting ele-
ments, chewing comfort will not be unduly limited.
To achieve this, expectations and individual thera-
peutic options should be discussed with the patient

1 I CBCT for evaluating the bone defects and the available
bone volume for possible retromolar bone harvesting.
3 I Intraoperative situation after extraction and explantation with aPDT disinfec-
tion (Helbo; bredent medical, Senden, Germany).
5 I Rimose alveolar ridge with healed soft tissue, eight
weeks after explantation.
well ahead of time, in the early planning stage. So
that a full-arch restoration can be supported by a
reduced number of implants, it is often necessary
to tilt the posterior implants to an angle of approxi-
mately 35° [17].
This extends the anterior-posterior support area
as far as possible without causing injury to the
anatomical structures in the mandible (mental fo-
ramen) or the maxilla (configuration of the floor
of the maxillary sinus). The criteria for immediate
59
CASE STUDIES
2 I Clinical situation. Pronounced chronic periodontal disease in the anterior
mandible.
4 I The removed implants show pronounced concrements
in the crestal region.
6 I Implant placement (blueSky; bredent medical) in an angulated position with
lateral bone augmentation near the implants and remaining explantation sockets.
restoration (or the length of the healing period for
submerged healing) are based on the anatomical
situation, the general health of the patient and the
specific recommendations that apply to the respec-
tive implant system [19].
By optimizing the implant surfaces, which today
are usually abraded and hot-etched, the definitive
restoration can be delivered after six to eight weeks –
both in immediate provisionalization cases and in
submerged healing (Figs. 5 and 6).
60
CASE STUDIES
7 I Modelling a framework for rehabilitation with a full-arch restoration
on four implants.
9 I No soft-tissue irritation is present at the time of delivering the denture with
its reduced-diameter abutments (SKY uni.cone 3.5 N; bredent medical).
Restorative treatment
Dental technicians and dentists appreciate abut-
ments that are easy to place and connect and that
provide a wide contact surface for the superstruc-
ture [3]. They facilitate a standardized procedure
at the mucosal level without requiring extensive
verification of the correct abutment positions. In
full-arch rehabilitations, providing a classic resto-
ration with a cast framework is time-consuming
and associated with high laboratory cost, with the
result that the use of adhesive bases or CAD/CAM
frameworks has become established in recent years
[9,13].
CAD/CAM framework designs need meticulous
preparation, as the ceramic veneer requires a uni-
form veneering thickness to avoid chipping [1]. If
the occlusion is not recorded with the necessary
precision, requiring subsequent modification, this
usually means that the restoration will require
8 I Detail finish of the framework made of a high-performance
polymer (BioHPP; bredent) before applying the opaque.
10 I Detail finish of the resin bridge with a basal contact
surface made of PEEK.
more frequent repairs due to the chipping that may
occur [14,22].
There are two preventive approaches that can
be considered established. A metal framework can
be fabricated using CAD/CAM. Alternatively, the
framework may be produced from a highly elastic
resin [15,16]. High-performance polymers can be pro-
cessed by pressing – no elaborate CAD/CAM design
programmes or milling procedures are required. By
adding a ceramic filler, the material achieves high
strength and a modulus of elasticity similar to that
of natural bone, which practically eliminates frame-
work fractures [26].
Compared to zirconia frameworks, these resin
frameworks are significantly lighter, which patients
perceive as comfortable because the foreign-body
sensation is reduced. Since the material also has a
very dense structure, water absorption is very low.
Surface changes associated with soft-tissue irrita-

11 I X-ray inspection before the removal of implant 37 (the radiolucency
at implant 42 is projection-induced).
tion or the inclusion of particles that cause disco-
louration are therefore not expected. On the basal
aspect, the definitive framework may be left in
continuous contact with the mucosa, as the high-
performance polymer exhibits a very favourable
soft-tissue reaction [10,27].
It should be noted, however, that the PEEK sur-
face is susceptible to mechanical roughening by
prophylactic measures. Therefore, the framework
should be completely encased with the same resin
as that used for veneering in all regions not in direct
contact with the mucosa.
The frameworks are veneered, after conditioning
with a special opaque and bonding system, with a
fixation composite, so that the prefabricated resin
veneers can be permanently attached to the frame-
work [25]. In addition to stable support, the configu-
ration of the abutments is important for the frame-
work design. At the centre of masticatory activity,
it is therefore advisable to use wide abutments,
rendering the contact surfaces of the superstruc-
ture almost identical to the buccolingual width of
the dental arch. However, this can lead to problems,
especially in the anterior mandible, because the
patients perceive an encroachment on their tongue
space following the loss of their mandibular ante-
rior teeth. Reduced-diameter abutments have the
advantage that they ensure a stable support of
the superstructure while being relatively slender in
shape (Figs. 7 to 12).
Recall
At delivery, the screw-retained restoration is seated
uniformly and free of tension by alternating the
application of torque to the retaining screws. This
61
CASE STUDIES
12 I Bridge reinserted after explantation. The screw access canals are
not sealed yet.
avoids tension and deformation and reduces the
risk of early screw loosening.
Other possible reasons for early loosening of the
retaining screws, in addition to an imperfect fit of
the superstructure, include a suboptimal occlusal
design and articulation [18]. Therefore, the occlu-
sion should be re-checked at a follow-up appoint-
ment two to eight weeks after delivery.
When delivering combination restorations –
screw-retained on the angulated abutments and
a semi-permanently cemented on the anterior
fixtures – the retaining screws must be tightened
alternatingly on the right and left, so that the ce-
menting on the anterior structures can also take
place uniformly.
It is important to check not only the occlusion
and articulation at the recall appointments but also
the periodontal status of the antagonistic dentition
to prevent displacement within the oral environ-
ment, possibly leading to peri-implant mucositis –
which in turn would need to be treated with aPDT
again [6].
To find the list of references visit the web (www.teamwork-media.de).
Follow the link “Literaturverzeichnis” in the left sidebar.
Contact address
Dr Jörg Neugebauer, PhD
Dr Bayer, Dr Kistler and Dr Elbertzhagen
Private Practice, Landsberg am Lech
Von-Kühlmann-Straße 1
86899 Landsberg am Lech
Germany
neugebauer@implantate-landsberg.de
www.implantate-landsberg.de
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64
PRODUCT STUDIES

The one-piece implant: a cost-effective and predictable treatment option

Quality long-term implant treatment

DR CHARLES D. SCHLESINGER, ALBUQUERQUE, NEW MEXICO, USA

As practitioners, we are faced with many challenges in our practices. The toughest challenge is being able
to provide the highest quality dentistry at a price point that works for our patients, yet still has room for
the profitability necessary to be a successful business. When relating this to implant dentistry, low patient
cost and profitability were mutually exclusive realities. With the proliferation of lower cost implants on the
market, the ability to provide treatment affordably is a reality.

Over the years, we have had issues when it comes
to long-term crestal bone stability following bone
level implant placement. First, the issues associ-
ated with butt joint implant-abutment connec-
tions were to blame. Micro-movement was the
perceived culprit. Two-piece non-welded implants
showed significantly greater crestal bone loss than
one-piece welded implants [1]. The implant indus-
try addressed this problem with the introduction
of platform-switched prosthetics, both with butt
joints and – more commonly – with conical con-
nections. Platform switching helps preserve crestal
bone [2]. Clinically, we still saw bone loss associated
with two-piece dental implants.
Retained cement (cement sepsis) resulted in sig-
nificant peri-implant inflammation and bone loss
around restored dental implants [3]. Today this ap-
pears to have become the catch-all solution when
it comes to explaining bone loss. But is it? Maybe it
is still the mechanical interface at or near the crest?
Only continued research will be able to pin down
the true cause.
The one-piece dental implant has been in exis-
tence since the early days of oral implantology. It
stemmed from the small-diameter implants (SDI)
initially developed for transitional uses. As these
SDIs became more popular, clinicians started to see
the advantages and long-term success of these im-
plants. In 2002, the Imtec MDI was the first FDA-
approved SDI for long-term use. In 2001, the O-Com-
pany, ahead of the curve, released a 3.0-mm diam-
eter long-term implant called the Mini.

1a 1b

1a and b I Preoperative OPG and CBCT.


2 I Preoperative intraoral photograph. 3 I No. 8 round bur.
5 I Paralleling pin. 6 I Guided tissue punch.
The full-size one-piece implant has a high long-
term clinical success rate as long as it can attain
sufficient primary stability. This stability is critical,
since this style of implant has no other option than
to be loaded immediately. Therefore, most implant
companies have shied away from manufacturing
larger-diameter one-piece implants due to the im-
possibility to gain sufficient primary stability with
the current macrostructural implant design.
The macrostructure of an implant – specifically
the thread design and the body shape – are crucial
to initial primary stability.
Clinical case
A 34-year-old female patient presented at the clinic
with a missing tooth 15. The bicuspid had been lost
approximately five months earlier due to a root
fracture secondary to extensive caries. The patient’s
medical history was non-contributory and her
oral health was excellent. A CBCT exam confirmed
enough bone volume to place a 3.25 x 14 mm im-
plant (Figs. 1a to 2).
Local anaesthesia was accomplished by buccal
and palatal infiltration with Septocaine (Septodont,
Lancaster, Pennsylvania, USA). A No. 8 high-speed
round bur was used to mark the initial osteotomy
position. Full periodontal tissue penetration with a
resultant crestal divot was achieved (Fig. 3). A 1.8-mm
65
PRODUCT STUDIES
4 I 1.8-mm pilot drill.
7 I Countersink.
pilot drill with an 8-mm drill stop was taken to full
length while establishing angulation in both the
buccolingual and mesiodistal directions (Fig. 4).
A 4.0-mm paralleling pin was placed in the pilot
hole to verify the angulation. The OCO Biomedi-
cal (Albuquerque, New Mexico, USA) paralleling
pin allows for the evaluation of not only the an-
gulation, but also the platform size and abutment
height (Fig. 5).
Due to the presence of sufficient keratinized tis-
sue, a flapless approach was chosen. The 4-mm
guided tissue punch removed concentrically the ap-
propriate amount of soft tissue around the intend-
ed implant site (Fig. 6). Once the tissue plug was
removed with a No. 8 round bur, a countersink was
used to the appropriate level to establish the proper
position of the implant platform. The countersink
(Fig. 7) is the key to being able to perform predict-
able flapless surgery and crucial for enhancing the
dual stabilization provided by the unique patented
OCO implant body. The countersink blades remove
the appropriate amount of bone regardless of crest-
al anatomy. The embedded tapered platform of the
implant, being machined, will be “at home” in both
hard and soft tissue. Without the countersink, there
would be no way to assure that the microthreads
of the implant were completely below the crest of
bone in all directions.
66
PRODUCT STUDIES
8 I Final pilot drill with 14-mm depth stop. 9 I 2.8-mm final osteotomy former.
11 I Final torque value.
The countersink had now changed the original
crestal height, therefore a 1.8-mm pilot, now with
a 14-mm depth stop attached (Fig. 8), was taken to
full length to the bottom of the well created by the
previous surgical step. This step is critical to suc-
cessful placement since the final osteotomy former
with its non-cutting tip will only drill as deep as the
pilot hole, and the implant will not proceed past
the depth of the final osteotomy former. Once the
final depth had been established, a 3.25-mm upper
(2.8-mm diameter) final osteotomy former was taken
to full length (Fig. 9). The osteotomy was flushed
with sterile saline to remove any debris and a small
paddle curette was used to assure 100 per cent bone
integrity 360 degrees around the osteotomy.
A 3.25 x 14 mm OCO Biomedical ISI implant (OCO
Biomedical) was chosen for this case. The ISI line of
implants consists of one stage, one-piece tissue-
level implants with a 5.5-mm tall abutment. The
3.25-mm diameter implant flares out to a 3.7-mm
restorative platform. The imbedded tapered plat-
form engages the cortical bone and helps provide
dual stabilization for good primary stability. The
ISI line has implants that range from 3.25 mm to
5.0 mm in diameter. All of these implants, along
with the standard-diameter and large-diameter
OCO implants, utilize a patented implant body de-
signed for immediate loading.
10 I 3.25 x 14 mm ISI implant.
12 I Implant in place.
Once removed from its non-sterile outer packag-
ing and its sterile inner vial, the implant was taken
to the osteotomy site with the attached Ultem
carrier (Fig. 10). After resistance was felt, the car-
rier was removed and the implant driven to final
position using a driver attached to a 30–90 N/cm
torque wrench. A final insertion torque of 75 N/cm
was achieved (Fig. 11). This torque indicated that suf-
ficient primary stability was established (> 35 N/cm)
and a successful outcome was predicted. An Osstell
unit cannot be used with a one-piece implant to
check stability, but a Periotest device could be uti-
lized if desired.
The interocclusal distance was not sufficient for
final restoration requirements (Fig. 12), so the abut-
ment portion of the implant was prepped with a
Great White carbide bur (SS White, Piscataway, New
Jersey, USA) under copious irrigation to assure suf-
ficient cooling and avoid overheating the implant
(Fig. 13).
With a flapless approach, minimal soft-tissue dis-
turbance occurred and predictable healing can be
expected. An added benefit is lower postoperative
patient discomfort compared to a full-thickness
periodontal elevation. The excess keratinized tissue
over the implant margins was removed with a pro-
filing bur, allowing the impression coping to seat
(Fig. 14). It was decided to take a final impression

13 I Adjusting the abutment.
15 I TRIP in place.
using the Identium impression material (Ketten-
bach, Huntington Beach, California, USA) and a TRIP
(Tissue Retraction Impression Coping) impression
coping (Fig. 15).
Since the abutment was modified and a machined
analogue was to be used for final restoration fabri-
cation, the analogue needed to be modified in the
same manner to duplicate the abutment profile in
the mouth.
The OCO Complete packaging (Fig. 16) includes
the analogue, two acrylic copings and the impres-
sion TRIP. One of the acrylic copings was used to
fabricate a reduction coping for the analogue. First,
the coping was placed onto the implant intraorally
17 I Modified acrylic coping.
67
PRODUCT STUDIES
14 I Profiling bur.
16 I Complete packaging.
and the excess material removed (Fig. 17). The cop-
ing was then placed onto the analogue and any ex-
cess was removed with the same Great White bur
(Fig. 18). Now both the analogue and the implant
had the same dimensions, and the laboratory was
able to predictably and accurately fabricate the fi-
nal restoration. The modified analogue was placed
into the impression by snapping it into the TRIP. Al-
ternatively, a retraction cord could have been used
and a conventional crown-and-bridge impression
taken. An opposing-arch alginate impression and a
bite registration were sent to the laboratory along
with the final impression for the fabrication of a
gold-ceramic restoration.
18 I Adjusted analogue.
68
PRODUCT STUDIES
19 I Cemented temporary.
The second acrylic coping was used to fabricate
the temporary restoration. A Protemp crown (3M
Espe, St. Paul, Minnesota, USA) was polymerized
and trimmed to establish the proper emergence
profile and contours. The temporary crown was
then cemented with IRM after the occlusion was
checked with articulating film (Fig. 19).
Two weeks postoperatively, the patient returned
to the clinic for final cementation of the definitive
restoration. The temporary was taken off and any
remaining cement removed from the abutment.
After a preliminary check of the crown’s marginal
fit, the occlusion was adjusted and the ceramic
surfaces polished to a matte finish with a rubber
wheel. The crown (Fig. 20) was cemented with
Improv cement (MS Biologics, Highland Township,
Michigan, USA). Once hardened, the excess cement
was removed and the patient was dismissed.
20 I
Final restoration.
Conclusion
The one-piece implant is a predictable, viable and
cost-effective option for implant treatment. The
advantage of a one-piece implant design is that
crestal bone stability is excellent since there is no
mechanical interface as in a two-piece implant.
The potential limitations of a one-piece implant
become evident if a trajectory of less than 10–15 de-
grees off-access cannot be established. In this case,
the amount of abutment reduction could compro-
mise the retentive form to an unacceptable level.
As a cost-effective treatment option, this type of
implant is an excellent choice. Besides the cost of
implant, the only additional cost is the final crown.
With full zirconia and e.max crowns in the $100
(€ 75) range these days, the potential cost savings
can be passed along to the patient. For a dentist
who utilizes CAD/CAM technology like Cerec or
E4D, it is as simple as placing the implant and scan-
ning. The patient can walk out after the implant has
been placed and the final restoration completed
within one appointment. Providing quality long-
term implant treatment to anyone who desires it
is possible.
To find the list of references visit the web (www.teamwork-media.de).
Follow the link “Literaturverzeichnis” in the left sidebar.
Contact address
Dr Charles D. Schlesinger
9550 San Mateo Blvd. NE, Suite C
Albuquerque, New Mexico, 87113
USA
chuck@ocobiomedical.com
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70
PRODUCT STUDIES

Digital complex implant rehabilitation using an intraoral scanner

What can we achieve?

DR LUIS CUADRADO DE VICENTE, MD, DDS, PRS, VALERIA GARCIA CHACÓN, DDS, PEDRO PABLO RODRIGUEZ, CDT,
CRISTINA CUADRADO CANALS, DDS, AND PELAYO GIL ABANDO, DDS, SPAIN

The fit and utility of the intraoral scanner has been discussed as a viable option when it comes to
implant therapy, especially in more complex cases where there are more than four implants to scan.
This case presentation intends to document the great results and outstanding precision to be achieved
with this fully digitized process, where the intraoral scanner is the key to the success of the whole treat-
ment. With an adequate treatment protocol, the scanner provides a digital bite index without requiring a
conventional registration or indeed any impression material. The cases presented were treated, following
our protocol, with Phibo and 3Shape, which offer clear benefits in complex cases. This new protocol facilitates
scanning for any patient with implants, from single-unit to complex situations up to ten implants per arch.
It also gives the dentist added benefits over the conventional traditional registration methods. It is a reliable,
simple, fast and accurate method. We believe it makes the traditional workflow obsolete.

Material All frameworks were connected directly at im-

The intraoral scanner used is the Trios by 3Shape
(Cart version), both the monochrome and the co-
lour version, avoiding the use of powder or sprays.
Twelve months ago, when we started develop-
ing our protocol, neither 3Shape nor Phibo had
indications for using the intraoral scanner for the
treatment of such complex cases. After reading this
article, you will appreciate the high precision of the
overall process.
Methods
Seventy patients were treated using this protocol,
with specific requirements for case selection. Pa-
tients treated with this protocol involved restora-
tions ranging from single-unit implants, two- to
four-unit bridges, mandibular and maxillary resto-
rations, bimaxillary restorations to using zygomatic
implants for the atrophic maxilla.
All implants were scanned directly at the implant
level, except for the atrophic maxilla treated with
zygomatic implants, which was scanned at the
multi-unit abutment level.
The implant connection used was Phibo TSH Im-
plant (external hex), except for the zygomatic im-
plants and one case restored with Nobel Biocare
implants that was also scanned at the implant level.
plant level, with no intermediate abutment, mak-
ing the situation more complex (again except the
zygomatic case).
Only the authors took part in the scanning pro-
cess, using the same step-by-step protocol. The
digital design process was performed by the same
dental technician, co-author of this article, using
the Sinergia by Phibo workflow.
Frameworks were processed and produced by the
Phibo Technological Centre following the Sinergia
workflow and quality specifications.
Different framework materials and abutments
were ordered, allowing us to compare accuracy be-
tween materials (PMMA, CrCo, Zirconia) as well as
customized abutments.
Protocol
The protocol used included two different scanning
processes:
A first scan before implant placement; a second
scan after implant placement.
Creating the digital study models
When selected in Trios to create study models
for a case, the software follows an easy three-step
process:

1 2
3 4
1. Scanning the lower arch
2. Scanning the upper arch
3. Scanning the occlusion on the left and right sides
This easy process is the key to success. Once the
scan has been completed, the dental technician
and dentist will have access – throughout the treat-
ment – to the initial aesthetics, occlusion and verti-
cal dimension.
Scanning the implants
Once these digital study models have been scanned,
the implants are put in place and the files are dupli-
cated. It is sufficient to digitally complete an order
for the laboratory for the software to “know” which
area of the previously scanned study models need
a re-scan with the implant information, maintain-
ing the aesthetics, occlusion and vertical dimension
from the original study models.
The implant-scanning process is divided into two
steps:
1. Scanning the emergence profiles of the implants
2. Connecting a scan body to the implant and re-
scanning
As one completes the first step and embarks on the
second, the software erases a 0-mm to 12-mm area
around the emergence profile of the implant. So
what actually happens is a re-scan of that specific
area with the scan body screwed to the implant.
If the patient has one to four implants to scan,
there will be no problem at all, as the areas erased
71
PRODUCT STUDIES
1 I
Sinergia CrCo
framework by
Phibo CAD-CAM.
2 I
Framework try-in.
3 I
Final full-arch
metal-ceramic
bridge.
4 I
Adequate aesthet-
ics and good lip
support thanks to
the prosthesis and
graft.
between the first step and second steps will not
overlap (unless the implants are too close to each
other).
When scanning a ten-implant bimaxillary resto-
ration, it may appear complicated to reproduce all
the information due to the overlapping software
processes, but with the new software updates pro-
vided by 3Shape, this problem has been dramati-
cally reduced.
Once all implants are scanned, the files are sent
to the laboratory by the Trios software. The dental
technician designs both the final prostheses and
the digital model and sends them to the Phibo Tech-
nological Centre, where all the cases are inspected
before processing and manufacturing the frame-
works and rapid-prototyping the digital model.
Using this protocol, restoring a case using an in-
traoral scanner becomes easier and, of course, more
precise and reliable.
Case presentations
Case 1 (Figs. 1 to 4)
Maxilla reconstructed with an iliac-crest graft. The
patient presented with an acrylic complete remov-
able denture. Four months after surgery, implants
were placed and, after an additional four months
to allow for osseointegration, digital impressions
with Trios were taken. In a fully digital procedure,
a full-arch metal-ceramic restoration screw-re-
tained directly at the implant level was delivered
(using Sinergia), providing complete recovery of
function and aesthetics.
 72
PRODUCT STUDIES

5 I 5 6
Clinical situation:
Initial X-ray.

6 I
X-ray after implant
placement showing
the temporary screw-
retained acrylic bridge
in place.

7 I
The immediate
temporary acrylic
prosthesis
(a conventional
prosthesis).

8 I Maxillary scan with Trios (old model) 9 I Occlusion of the study-model scan file. 10 I Once copied, the new file is completed
with the provisional restoration in place. with the implant order. The implant position
This is the study-model scan. is marked and a new scan is taken for the im-
plants only. This is the emergence-profile scan.

11 I Scanning the scan bodies. Care must be taken to include the flat 12 I The final interarch relationship based on the information obtained
part of the scan body in a visible area. from the study-model file.

Case 2 (Figs. 5 to 23)
Advanced periodontal disease. All maxillary teeth
were removed and immediate implant placement
was performed. Conventional impressions were
taken and an immediate fixed temporary acrylic
prosthesis was delivered, screw-retained on six of
the eight implants placed.
This prosthesis provided the correct aesthetics,
occlusion and vertical dimension for the patient.
After four months, a scan was taken for the digital
study models, creating a file containing all the infor-
mation needed for the desired design of the final
restoration, including the actual situation with the
temporary prosthesis in place.
Duplicating this file in Trios as a preparation al-
lowed us to open a new file for the final prosthe-
sis, and the only re-scans needed were those of the
implant emergence profile and the implant scan
bodies.
The dental technician received all the informa-
tion for the final digital design, delivering a Sinergia
prosthesis.
 73
PRODUCT STUDIES

13 I An all-digital rapid-prototyping model 14 I CrCo framework by Phibo CAD-CAM on 15 I The eight-implant framework. There are
by Phibo CAD-CAM with the implant ana- the digital model. no intermediate abutments; the prosthesis is
logues in place. connected directly at implant level.

16 17

16 I
Try-in of the same
framework.

17 I
AP view showing
the framework.

18 I Try-in of the digital framework on the initial con- 19 I Excellent fit of the same framework on the digital
ventional cast used to deliver the provisional acrylic pros- model, showing the impressive precision of the whole
thesis. It evidently does not fit, proving that the digital process, with a passive fit on the implants.
registration has a better fit and is more precise than the
conventional one. We were able to screw the provisional
prosthesis onto the implants because it was made of a
flexible material, acrylic resin, reinforced only with a wire.

20 21
20 I
The final PFM
Sinergia full-arch
bridge on the digital
model.

21 I
X-ray showing the
excellent fit of the
framework.

22 23
22 I
The final prosthesis
in place.

23 I
Final result.
74
PRODUCT STUDIES

24 I 24 25
Clinical situation:
Initial X-ray.

25 I
Intraoral view
at surgery.

26 I 26 27
Immediate surgical
scan file.

27 I
Clinical appear-
ance with healing
abutments five
days after implant
surgery.

28 I 28 29
Same day,
occlusal view.

29 I
Provisional digital
PMMA bridge on
the digital model.

30 I 30 31
Close-up of
the same digital
prosthesis.

31 I
Prosthesis in place.
Occlusal view.

32 I 32 33
PA view.

33 I
Clinical situation
several months later.

Case 3 (Figs. 24 to 43)

This was one of our first Trios patients. Teeth 33–43 rectly after the surgical procedure, and a provisional
were extracted and four Phibo TSH implants were immediate Sinergia PMMA bridge was delivered and
placed immediately. The situation was scanned di- placed five days after surgery.
 75
PRODUCT STUDIES

34 35
34 I
Scan bodies in place
for the final scan.

35 I
Screenshot of
the final scan file,
showing the
implant profile.

36 37
36 I
The scan body
screen after comple-
tion of the scan.

37 I
Final digital Sinergia
model with the
implant analogues
in place and remov-
able soft tissue.

38 39
38 I
Final Phibo
CAD-CAM CrCo
framework in place.

39 I
Occlusal view.

40 41
40 I
Finished Phibo
CAD-CAM Zirconia
framework on the
digital model.

41 I
Finished Zirconia
and ceramic
prosthesis.

42 43
42 I
Finished restoration
in place.

43 I
Control X-ray.

After four months of tissue healing, the patient retained directly at implant level. This allowed us to
was re-scanned for the final restoration. Two bridges compare the passive fit of the two materials pro-
were delivered, in CrCo and Zirconia, both screw- duced from the same scan file.
76
PRODUCT STUDIES

44 I 44 45
Clinical situation:
Initial X-ray. Note
the previous im-
plant treatment and
failing dentition.

45 I
Clinical appearance
at consultation.

46 I 46 47
PA view during the
first scan for provi-
sional prostheses.

47 I
Final scan.
Upper maxilla.

48 and 49 I 48 49
Intraoral view of
the final bimaxil-
lary metal-ceramic
prostheses.

50 I 50 51
Delivery X-ray
control.

51 I
Final result.
Remarkable
improvement in
terms of function
and aesthetics.

Case 4 (Figs. 44 to 51) Acknowledgement

A complex all-digital case. The patient presented
with old implants and a failing dentition. A case
with ten maxillary implants and nine mandibular
implants was diagnosed.
A staged approach was planned that included
placement of new implants to safeguard the clini-
cal situation and to support the professional activi-
ties of the patient. We initially delivered bimaxillary
Phibo CAD-CAM full-arch temporary screwed-re-
tained PMMA prostheses on the old and the new
implants. Final digitally designed prostheses were
delivered four months after the placement of the
new implants.
We would like to thank the Sinergia staff of Phibo
and 3Shape for their support in the completion
of this protocol. Special mention is due to Rodrigo
Clavel, Alex Aznar, Vanesa Fal and Helena Piulachs
and to the entire i2 staff.
To find the list of references visit the web (www.teamwork-media.de).
Follow the link “Literaturverzeichnis” in the left sidebar.
Contact address
Dr Luis Cuadrado de Vicente
Centro Clínico i2 Implantologia
Nuñez de Balboa, 88 · 28006 Madrid · Spain
luiscuadrado@me.com
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Five field-of-views (FOV)
Low Dose Technology™ (LDT)
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78
PRODUCT STUDIES

Focus on a new technique

Closed hydraulic sinus floor elevation

with simultaneous implant insertion
DR LOP KEUNG CHOW, BDS, MDS (ORAL AND MAXILLOFACIAL SURGERY), MOSRCS (EDIN), FDSRCS (EDIN), AND
DR SHUI CHEONG SIU, BDS, MDS (PROSTHODONTICS), HONG KONG

The closed sinus lift was first performed by Tatum in 1974 and later published by Summers in 1994 [1]; it is
now known as the “Summers technique”. This technique involves a crestal incision. The sinus lining is lifted
transcrestally using an osteotome. The procedure is considered minimally invasive, with patients experiencing
less swelling and discomfort postoperatively compared with traditional open sinus lift procedures. The most
common complication of the open sinus lift grafting is intra-operative perforation of the Schneiderian mem-
brane. Reported perforation rates range from 20 to 44 per cent, whereas perforation rates for the closed sinus
lift have been reported as 0 to 25 per cent [2-4]. In addition, postoperative swelling and haematoma have
been reported in 65 per cent of patients with an open sinus lift [5].

Chen and Cha first described the hydraulic sinus
floor elevation in 2005. Here, a 3-mm round dia-
mond bur was used to start the osteotomy, the drill
stopping about 1 mm short of the sinus floor. A
2-mm sinus bur was used to create a pinhole bore
at the end of the osteotomy. Hydraulic pressure was
applied to the osteotomy site by a high-speed air
turbine handpiece to raise the Schneiderian mem-
brane, followed by the condensation of grafting
materials below the raised membrane.
This article describes a new technique for the hy-
draulic closed sinus lift using a specialized implant
(iRaise, Maxillent, Israel) that has a built-in internal
channel to act as sinus floor elevation device. This
internal channel facilitates the introduction of fluids
and bone-graft materials through the implant body
into a space beneath the Schneiderian membrane.
It also allows a simultaneous sinus lift and full-
length implant insertion in a single procedure.

1 I Preoperative CT showing bone height at sites 16 and 15.
Clinical case
A 61-year-old male patient presented with miss-
ing teeth 15 and 16. A CT was taken and confirmed
a residual bone height of approx. 5 mm at site 16,
which was not sufficient for a regular-length im-
plant. The bone height at site 15 was adequate.
The treatment plan included a sinus lift and graft-
ing with simultaneous implant placement at site
16 and a conventional implant at site 15. The right
maxillary sinus appeared to be healthy on the CT
scan (Fig. 1).
 79
PRODUCT STUDIES

2 3 4
2 to 7 I
Marking drill,
pilot drill, flat drill,
cortex drill.

5 6 7

8 9
8 and 9 I
The sinus-lift
implant;
insertion of the
implant in the
osteotomy.

10 11 10 and 11 I
The tube connector
in place with saline
and bone-graft
injection.

Surgical phase (Figs. 2 to 14)
An iRaise (Maxillent, Israel) sinus-lift implant was
used to perform the hydraulic sinus floor elevation
and bone grafting. A crestal incision was made over
the implant recipient site and a full thickness uni-
lateral mucoperiosteal flap was raised. The implant
at site 16 was placed first; its position was marked
with a 2-mm round bur, followed by the 2-mm pi-
lot drill. The flat drill was then used to continue the
osteotomy until the cortex of the sinus floor was
reached. Finally, the cortical bone of the sinus floor
was weakened by a diamond cortex drill. The sinus-
lift implant was inserted into the osteotomy site
to penetrate the sinus floor; blood came out from
the coronal opening of the channel once the im-
plant reached below the Schneiderian membrane.
The tube connector was adapted onto the implant
body. 2 ml saline solution were injected through the
internal channel, which pressed against the sinus
membrane and detached it gently from the sinus
floor. The saline was drained from the sinus, and
bone-graft material was injected into the sinus by
the same route. The adapter was removed and the
implant fully inserted into the osteotomy. The cover
80
PRODUCT STUDIES

12 and 13 I 12 13
Bone-grafting
materials are
extruded from the
opening of the
internal channel;
the sinus-lift
implant has been
fully inserted.

14 I
A regular implant
was placed at site 15.
Cover screws in situ.

15 I
Immediate
postoperative CT
showing the lifted
sinus lining.

screw was connected and the flap closed with ab- was well seated inside the bone graft in the cavity
sorbable Vicryl sutures. The postoperative CT (Fig. 15) created. There was minimal pain and swelling dur-
showed that the sinus lining had been raised about ing the postoperative period. The patient was able to
15 mm without perforation. The sinus-lift implant resume his daily activities the next day.
 81
PRODUCT STUDIES

16 I Following an uneventful three-month period in the maxilla,
the definitive impression was taken at implant level using open-tray
impression copings (15: NobelBiocare, Sweden; 16: Maxillent iRaise,
Israel). A digital radiograph was used to verify the complete seating
of the impression copings. The impression was taken using a custom
tray and polyether (Impregum, 3M Espe, Germany).
17 I Implant analogues (NobelBiocare, Sweden; Maxillent iRaise,
Israel) were connected to the impression copings. A master cast was
fabricated with soft-tissue analogue (G Mask, GC, USA) and type IV
dental stone. Non-engaging temporary abutments were screwed
onto the master cast. Maxillary and mandibular casts were mounted
on a semi-adjustable articulator (Artex, AmannGirrbach, Germany).
A temporary bridge was fabricated with a low-shrinkage acrylic
resin (GC Pattern Resin, GC, USA) and acrylic teeth (Ivoclar Vivadent,
Liechtenstein).

18 I The temporary bridge was tried in in the patient’s mouth and checked for interproximal 19 I The mounted master casts, soft-tissue
contacts and occlusal adjustment. The design of the implant framework was to provide for analogue and tried-in temporary bridge were
metal on the occlusal surface and a buccal ceramic veneer. The precise occlusal contacts on the digitized by a model scanner (Zfx Evolution,
temporary bridge were greatly important for the subsequent scanning workflow. Zfx, Germany).

20a and b I The cut-back for the buccal ceramic veneer (0.8 mm) was performed by CAD software (Zfx CAD Software, Zfx, Germany).

Restorative phase Discussion

The steps of the restorative phase are shown in The sinus-lift implant offers several advantages over
Figures 16 to 25. the conventional open sinus augmentation. There was
minimal postoperative pain, swelling and bruising
82
PRODUCT STUDIES

21 I The final CAD data of the implant-supported bridge framework was sent to the milling centre and subsequently milled.

22 I The fit of the cobalt-chromium framework 23a and b I A dedicated ceramic material (VM13, Vita, Germany) was used for
(Zfx, Germany) was assessed on the working cast. ceramic veneering with a coefficient of thermal expansion of 13.1–13.6 K-1. The
ceramic veneer was fabricated according to the manufacturer’s instructions.

because extensive flap raising and bone removal
were avoided. The procedure can be performed un-
der local anaesthesia, whereas the conventional
open sinus lift usually requires intravenous sedation
or general anaesthesia. Therefore, the procedure is
suitable for patients with a high anaesthetic risk.
Moreover, the extent of the sinus floor elevation was
much greater than with the closed sinus lift using
the osteotome approach, which was essentially a
mechanical tenting of the sinus lining.
This patient had received an open sinus lift on
the contralateral side (teeth 26) a year previously.
He reported that the postoperative recovery was
more rapid and the discomfort was much less with
the sinus-lift implant compared with the open sinus
lift. The author has completed five comparable cases
 83
PRODUCT STUDIES

24 I The definitive implant-supported CAD/CAM bridge with metal occlusal surfaces was inserted. A periapical radio-
graph was taken to verify the complete seating of the implant bridge on the implants. The abutment screws were tight-
ened according to the manufacturer’s instructions (35 Ncm). The CAD/CAM system can reproduce the interproximal and
occlusal contacts of a temporary bridge or resin pattern precisely (to within 20 μm). No occlusal adjustment was required.

25 I
Six-month post-
operative CT
showing the
consolidated
sinus graft and
finished restoration.

so far. No perforation and no infection have occurred, Contact address

and all implants were successfully restored. Dr Lop Keung Chow
Dental Implant and Maxillofacial Centre
1901-05, The Centre, 99 Queen’s Road Central
To find the list of references visit the web (www.teamwork-media.de). Hong Kong
Follow the link “Literaturverzeichnis” in the left sidebar. rlkchow@gmail.com
84
PRODUCT STUDIES

Characterizations of MIS implant surfaces

Proven quality
DR TAL REINER, ISRAEL

Long-term clinical success of dental implants is dependent on a number of critical factors including implant
design, bone quality and quantity, surgical techniques and the clinician’s skills. However, beyond implant
materials and geometry, topography and chemistry, the implant’s surface treatment and surface quality
are just as important for achieving high success rates.

Improving osseointegration cleaning and sterilization procedures. Surface con-

Numerous studies suggest that the osseointegra-
tion of implants is more predictable and more rapid
with implant surfaces treated with a combination
of sandblasting and acid-etching. Osteoblast prolif-
eration and differentiation depend on the micro- and
nanostructures of the implant surface closely mim-
icking the natural bone matrix. MIS implant surfaces
replicate the natural cancellous (spongy) bone con-
figuration and exhibit greater surface purity than
other major implant brands when viewed by SEM.
Managing contaminants
The chemical composition of implant surfaces can
vary depending on manufacturing finishing steps
such as titanium machining, thermal treatment or
taminants such as trace metals, ions, lubricants and
detergents left over from machining and cleaning
processes require a careful check of implant sur-
faces in a separate procedure to ensure the quality
of the implant.
MIS implants undergo routine stringent surface
characterization and validation procedures using
SEM (scanning electron microscopy) and XPS (x-ray
photoelectron spectroscopy) to confirm low levels
of carbon on the implant surface and minimal levels
of other contaminants.
Conclusions
Using surface characterization technology, MIS can
guarantee that their implant surfaces uphold the

Identification card and codification of the chemical and morphological charac- BSE images of MIS Seven implants.
teristics of the MIS Seven implant.
 Wisdom
The new
Tooth Elevators
are designed to extract
impacted wisdom teeth
with conical or rounded
roots (wisdom tooth “buds”)
in one piece.

not necessary to cut the

tooth into pieces with a
bur and by this,
no risk that the tooth
rotates or swivels in the
bony socket.

Mid-section of the MIS Seven implant: BSE (left), SE (right).

SE image x 2000
of the MIS Seven
implant.

highest standards of surface quality – 99.8 per cent to 100 per cent pure
titanium oxide – and validate full coverage of the surface by the sand-
blasting and acid-etching processes. These surface treatments help elimi-
nate various surface contaminants while increasing the implant surface
area, generating a hydrophilic surface with micro- and nanostructures for
optimum osseointegration.
Refer to the complete scientific article in “News 37 – Characterizations
of MIS Implant Surface” on the MIS website at www.mis-implants.com/
Scientific/ResearchMaterials.aspx.
These conclusions are supported by an independent research article
published in The Poseido Journal 2014; 2(1): “Identification card and codifi-
cation of the chemical and morphological characteristics of 62 dental im-
plant surfaces”, according to which no pollution or chemical modification
was detected on the MIS Seven implant, titanium grade 5 ELI, grade 23. Only
three out of 62 implants tested evidenced similar results, the MIS Seven
coming out on top.

Access the complete article at
www.poseido.info/pub-
lication/volume-2-2014/
poseido-20142137-55-
dohan.pdf
Contact address /\QR[`RRNYYRR !#  $% @a\PXNPU  4R_ZN[f
ARY' !& $$$ #!&&&  3Ne' !& $$$ #!&&&"
Dr Tal Reiner dddX\UYR_ZRQVgV[aRPU[VXQR
Materials Discipline Manager
MIS Implants Technologies Ltd
www.mis-implants.com
86
PRODUCT STUDIES

Immediate implant-supported restoration of a single-tooth gap using a chairside CAD/CAM system

Fast and reliable

DR ROBERT SCHNEIDER, NEULER, GERMANY

The immediate placement of implants in extraction sockets opens up the possibility of a timely aesthetic and
functional rehabilitation, if a suitable indication exists. Combined with immediate restoration procedures, it
shortens the treatment time and reduces cost. The present article describes a relatively new approach, where
a protocol was developed that uses an intraoral scanner and chairside CAD/CAM to provide fast and reliable
single-tooth restorations.

The outcome of an implant-prosthetic treatment Immediate implant placement and CAD/CAM

is defined not only by successful “osseointegra-
tion” but also by other parameters, some of them
subjective. For example, patient comfort should be
included in the assessment. Patient comfort in turn
will often depend on how long the treatment takes.
In this context, immediate placement is gaining in
importance, because the drawbacks of the conven-
tional protocol (delayed or late placement) include
the long time required to complete the therapy
and the number of surgical interventions required.
Where a strict indication exists, immediate implant
placement is an accepted alternative [5]. Benefits
include, in addition to maximum mobilization of
natural healing processes and reduced bone resorp-
tion, a smaller number of surgical interventions and,
consequently, a positive psychological effect on the
patient, who does not have to live with a tooth gap
or an ill-fitting temporary restoration.
1 I
Sky elegance
abutments:
Titanium attach-
ment and a sleeve
made of BioHPP
high-performance
polymer.
Immediate implant placement is the one-stage
placement of an implant in a fresh extraction sock-
et. Combined with immediate restoration, this sig-
nificantly shortens the duration of the treatment.
There is sufficient evidence in the literature that
immediate placement and restoration are feasible
in the case of single-tooth gaps [4].
If, in addition, CAD/CAM technology is used for
fabricating the superstructure, the process can be
optimized even further. Modern chairside systems
in combination with intraoral scanners offer high
precision and a wide variety of available materials
for provisional and definitive restorations for single-
tooth gaps or short bridges. Thus, new possibilities
open up for the experienced user, especially when it
comes to immediate restoration.
In general, the range of indications for immedi-
ate implant placement is relatively narrow. But if
all the rules of implantology are respected and no
patient-specific parameters contradict it, placing an
implant directly after extraction is not, in our view,
associated with any increased risk. Most publica-
tions describe long-term results that are identical
to the success rates with late implant placement.
This makes immediate placement a suitable treat-
ment method for experienced operators [2, 7]. If the
morphology of the hard tissues prevents the inser-
tion of a properly sized implant with adequate pri-
mary stability, implant insertion immediately after
extraction or the immediate restoration of the im-
plant should not be considered. Various approaches
have been discussed in the literature for restoring
implants in fresh extraction sockets, most with
similarly good prognoses [1-4, 7]. What is required is

2 and 3 I Baseline situation: Tooth 25 is destroyed down to root level. It was decided to extract the tooth and immediately place an implant.
primary stability of the inserted implant to reduce
relative movements at the implant/bone interface
to physiologically acceptable levels. The attenua-
tion of loads by using suitably flexible prosthetic
components supports this goal.
Preliminary considerations
Patient acceptance of implant treatment is grow-
ing, provided the treatment can be carried out
quickly in relatively few treatment sessions. Against
this background, the Sky fast & fixed treatment
(bredent medical) has for us become a success fac-
tor in the immediate rehabilitation of the soon-
to-be edentulous jaw. However, at the time we
treated the present case, we lacked a comparable
standardized protocol with predictable results for
single-tooth gaps. A relatively new concept, the Sky
elegance abutment (bredent medical), was the so-
lution, the full benefits of which can be enjoyed in
combination with a chairside CAD/CAM. The PEEK-
based BioHPP Sky elegance abutments are easy to
scan without powder, causing no irritation in the
fresh wound. Based on the scan, the temporary
crown can be designed on-screen, then milled and
delivered to the patient.
The Sky elegance abutment concept
The Sky elegance abutments combine the advan-
tages of a provisional and definitive structure and
consist of a novel material combination: a sleeve of
BioHPP high-performance polymer is pressed onto
a titanium base, without gaps (Fig. 1). The BioHPP,
which has been approved as a class IIa medical de-
vice, is a semi-crystalline pigmented thermoplas-
tic material based on PEEK (polyetheretherketone)
that contains about 20 per cent ceramic fillers. Be-
cause of the bone-like flexural modulus of elasticity,
about 4 GPa, the material is able to absorb the mas-
ticatory forces acting on an implant (off-peak). The
attenuating characteristics of the BioHPP mitigate
load peaks at the inserted implant and transmit them
87
PRODUCT STUDIES
to the bone at reduced levels, facilitating progres-
sive bone loading [11] that reduces the load on the
local bone [10]. In addition, the bright colour of the
BioHPP helps prevent grey shadows in the gingival
area [8, 12, 13]. In our experience, the peri-implant
soft tissues react very positively to BioHPP, particu-
larly in terms of gingival apposition. The values for
water absorption, water solubility and plaque affin-
ity of the inert material are low, below the require-
ments of the applicable standards [8, 12, 13].
The prefabricated Sky elegance abutments come
in six different forms to select from according to the
indication on hand. Due to the round base shape,
the 0° and 15° angulated abutments with three dif-
ferent diameters can close each gap in a manner
that requires only minimal modification at the gin-
gival margin. Because the screw hole is located in
the titanium base, the abutment can also be used
as a definitive abutment. This in turn makes it un-
necessary to disturb the gingiva attached to the
abutment and avoids contamination when replac-
ing the superstructure. No healing or impression
abutments are needed.
Baseline situation and treatment planning
The 54-year-old female patient presented with a
tooth 25 fractured to the root (Figs. 2 and 3). The ad-
jacent teeth 26 and 24 had been restored with suf-
ficient ceramic crowns. The patient’s oral hygiene
was excellent and her general health was good.
There were no hard- or soft-tissue defects, and the
patient had no known contraindications. The at-
tached gingiva was thick enough, which favoured
immediate implant placement. To obtain a stable
long-term result, we opted for a single-tooth im-
plant at site 25. The patient requested a short and
minimally invasive treatment. She was very pleased
with the option of a chairside CAD/CAM temporary
crown. Having been informed of the risks and alter-
native treatment approaches, the patient agreed to
the treatment plan.
88
PRODUCT STUDIES

4 I Acquisition of digital data for chairside fabrication of a temporary 5 I The clinical situation was transferred to the software.
restoration.

6 I The design of the temporary crown ... 7 I ... was created automatically by the software.

8 I Virtual crown design. 9 I Occlusal check.

Surgical procedure Immediate restoration

On the day of surgery, the remaining root 25 was
removed atraumatically, being careful not to dam-
age the hard tissue, especially the facial lamella.
Extraction was followed by thorough curettage
of the periradicular granulation tissue, affording
maximum protection to the continuity of the facial
soft tissue. Probing revealed an intact facial lamel-
la, so there was no obstacle to immediate implant
placement. The implant (blueSky; bredent medical)
was inserted according to the protocol. A horizontal
distance of 2.5 to 4 mm between the implant and
the adjacent tooth is significantly associated with
the formation of a complete interdental papilla [9].
A primary stability of about 50 Ncm was achieved,
facilitating immediate restoration.
The abutment (M 15°) was slightly shortened and
customized extraorally and connected to the im-
plant at a torque of 25 Ncm. The clinical situation
was acquired with an intraoral scanner (PlanCAD-
CAM; Planmeca) without requiring scanning pow-
der (Fig. 4). Based on the STL data of the intraoral
scans, the slightly reduced crown contour was
designed on-screen (PlanCAD Easy; Planmeca), a
process that is performed mostly automatically by
the software (Figs. 5 to 9). Finally, we had to make
sure that no occlusal contacts or cantilevers were
present. After only a few minutes, the data could be
imported into the software of the milling machine
(PlanMill 40; Planmeca) and the restoration milled
from a composite blank (Telio CAD; Ivoclar Vivadent).
10 I Immediate restoration in situ at site 25. Composite
crown on a Sky elegance abutment.

After minor finishing and customization on the

spot, the crown was delivered and cemented using
a temporary cement (Fig. 10). Any occlusal contact
was avoided, as were cantilever or lateral loading.
Following a final check of the functional param-
eters, the patient could leave the practice with a
fixed immediate restoration in place after about an
hour.

Summary
During the following weeks, the provisional restora-
tion on the BioHPP Sky elegance abutment and the
composite crown ensured safe healing and osseo-
integration of the implant. As expected, soft-tissue
apposition occurred on the BioHPP surface, pro-
viding optimal conditions for the upcoming final
restoration. It is planned to produce even the final
restoration at chairside by intraoral scanning and
CAD/CAM.

Conclusion
Immediate implant placement is a safe therapy if
a suitable indication exists. Advantages include the
high level of patient comfort and the short dura-
tion of the treatment. By minimizing the number of
process steps and thanks to the efficient CAD/CAM-
based approach, the Sky elegance abutment con-
cept described here was able to accommodate the
patient’s wishes for a quick treatment at affordable
treatment cost. We observed very good treatment
results, since the soft tissue is not repeatedly trau-
matized in the preparation of the final prosthetic
restoration.

To find the list of references visit the web (www.teamwork-media.de).

Follow the link “Literaturverzeichnis” in the left sidebar.

Contact address
Dr Robert Schneider and colleagues
Tannenstraße 2
73491 Neuler · Germany
www.zahnarzt-neuler.de
90
BUSINESS & EVENTS

5th International Camlog Congress in Valencia

The best years are yet to come

When you hear a phrase like this, you might think it was just some pep phrase after a time of too many
disappointments to help you not to give up just yet. But if you – like Camlog – have just had ten years of
unbroken success, the same phrase sounds more like a fan choir. An enormously motivated team presented
itself at the 5th International Camlog Congress in Valencia, more cosmopolitan than ever before, with more
than 1,300 visitors from 23 countries, with clinically proven concepts and sophisticated digital solutions for
the future, and with a strong partner, Henry Schein – all set for an international breakthrough. The Palau de
les Arts with its spectacular architecture already made the morning walk to the congress venue a first-class
experience – just like the equally first-class programme.

One day before the official opening of the congress
under the motto of “The ever-evolving world of im-
plant dentistry”, Camlog offered a full eight practical
workshops – many of which had already been fully
booked in advance. In addition to the main proceed-
ings in English, German and Japanese, as a special
tribute to the host country and to the two congress
presidents, Professors Mariano Sanz (Madrid, Spain)
and Fernando Guerra (Coimbra, Portugal), an all-day
symposium “España y Portugal” was offered in the
Iberian languages and enthusiastically received by
200 attendees.
For the first time, a Camlog congress built on
the Consensus Report of the Camlog Foundation,
whose proceedings had also been accepted for
publication in the prestigious journal Clinical Oral
Implants Research (COIR). The issues and discus-
sions addressed at two meetings with 80 partici-
pants from 18 countries, with the aim to transform
scientific findings into actionable concepts, were
encased in a programme that left nothing to be
desired. Friday was devoted to multifactorial im-
plant decision-making processes related to the
specific requirements of periodontally compro-
mised patients, to immediate loading and the
influence of age in edentulous patients all the
way to treatment strategies in implant failure.
Evidence-based surgical concepts and recommen-
dations followed, with special emphasis on correct
implant positioning. The prosthetic concepts and
recommendations that concluded the first day of
the congress were devoted specifically to differ-
ent loading times and the influence of platform
switching.
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BUSINESS & EVENTS

Michael Ludwig, CEO Camlog Vertriebs GmbH, with Dr Rene Willi, Henry Schein, At the workshops, the world is getting smaller.
congress president Professor Mariano Sanz and Peter Brown, CEO Camlog (from left).

On Saturday morning, Professor Jürgen Becker,

president of the Camlog Foundation, hosted the
programme point dealing with the transforma-
tion of scientific findings into practical treatment
concepts. Issues such as template-guided implant
placement, short implants, the prevention of peri-
implantitis, implantology-related nerve irritation as
well as insertion torques and primary stability cov-
ered many popular questions. The continuation was
not without controversy – concepts such as “One
abutment – one time”, digital technology in daily
practice, and the times and procedures for bone
augmentation raised many points that attend-
ees took with them to discuss during the breaks.
Fiesta en familia.
The congress, with its 66 international academic
speakers and presenters and experienced practitio-
ners from twelve countries, culminated in a panel
discussion on “Complications – and what we can Peter Brown, the new CEO of Camlog, added that
learn from them”, which congress participants were “the users of the implant systems are not our custom-
welcome to participate in. The previous day, Michael ers, but our partners – that is written into the DNA
Ludwig, CEO of Camlog Germany, had already high- of Camlog”. Not least the exceptionally low staff
lighted this particular point: “Camlog does not just turnover at Camlog has created and strengthened
sell implants. As a manufacturer of medical devices, this partnership with their customers. This became
we carry great responsibility.” tangibly evident at the legendary Camlog Congress
celebration, this time held as a “Fiesta en familia” on
a real hacienda, where a model of an entire Span-
ish village had been erected complete with the cul-
tural traditions and culinary delights of the Iberian
Peninsula. More than 1,300 guests experienced an
unforgettable evening full of Spanish vitality and
temperament. And because the future of implant
dentistry is bright due to the aging of baby boom-
ers and expanding foreign markets, there can be no
question that the best years are in fact yet to come.
STE

More information
Professor Wilfried Wagner (Mainz, Germany) lecturing before a full house. www.camlog.com
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94
BUSINESS & EVENTS
Nobel Biocare DACH Symposium in Munich
Where clinical practice
gets its inspiration
“The patient in focus – Contemporary treatment concepts in oral implantology and CAD/
CAM” was the motto of the Nobel Biocare DACH Symposium in Munich in late June 2014.
Its scientific director Professor Friedrich W. Neukam (Germany) and his top-notch scientific
committee had arranged for presentations on a wide range of topics.
One of the highlights of the symposium was the
moment when Professor Friedrich W. Neukam offi-
cially inaugurated the Foundation for Oral Rehabili-
tation (FOR) for the DACH region (Germany, Austria
and Switzerland), presenting the results of the first
FOR Consensus Conference, which had investigat-
ed aspects of rehabilitating the edentulous jaw. In
the mandible, an overdenture on two implants ap-
pears reliable, and on four implants in the maxilla.
To support a fixed maxillary restoration, four to six
implants are sufficient. For a fixed rehabilitation on
four implants, the All-on-4 concept with two angu-
lated implants in the posterior region seems reli-
able. However, randomized controlled comparative
studies are still missing.
Another highlight was surprise guest and keynote
speaker Bertrand Piccard (France). The solar flight
pioneer spoke of his desire to throw off ballast to
discover new things and transcend boundaries.
How much aesthetics can be predictably achieved?
For Dr Peter Wöhrle (USA), the integrated treat-
ment approach has opened up new dimensions
for a more predictable procedure. Aesthetics in the
anterior region crucially depends on the correct im-
plant position, which can now be digitally designed
and precisely implemented using the guided sur-
gery concept. With regard to long-term aesthetics,
Wöhrle perceives a clear advantage for screw-re-
tained prosthetic solutions, even in the anterior seg-
ment. Biological aspects, too, are increasingly at the
centre of attention. The fascinating 3D animation by
Dr Peter Schüpbach (Switzerland) made the integra-
tion of implants into the soft tissue and the bone at
the cellular level an almost tangible experience for
participants. He showed how the bone fragments in
combination with a highly osteoconductive surface
such as TiUnite contribute significantly to active
bone formation.
Extended treatment options
How many implants are necessary for the restora-
tion of the edentulous jaw? Dr Stephen Parel (USA)
made the point that four implants in the mandible
are generally acceptable. Even a restoration sup-
ported by three implants can sometimes work. The
maxilla should receive more than four implants.
Dr Wolfgang Bolz (Germany) recounted the back-
ground histories of several edentulous patients. For
them, the All-on-4 concept had meant fulfilment
of their desire for a fixed prosthesis without hav-
ing to suffer through several months of treatment
with extensive augmentation procedures. Professor
Regina Mericske (Switzerland) spoke about the aes-
thetic rehabilitation of the edentulous patient. It is
important to take account of each patient’s indi-
vidual traits. Structured processes are required from
the planning to the prosthetic phase when providing
rehabilitations with extensive bridge frameworks.
CAD/CAM frameworks are more accurate and exhibit
a better fit than conventionally produced frameworks.
Thirty years of implant treatment
Professor Torsten Jemt (Sweden) presented results that
were quite surprising. For example, the probability
of implant failure actually seems to be higher in pa-
tients with a strong immune system. Dr Oded Bahat
(USA) explained how to approach complex cases
from a practitioner’s point of view. The goal should
be defined first, taking the patient’s specific situation
into account. Treatment planning should also con-
sider the potential ramification of advancing patient
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96
BUSINESS & EVENTS
Controversial dis-
cussions followed
the lecture blocks:
(left to right)
Dr Giorgio Tabanella,
Professor Christer
Dahlin and Professor
Eric Rompen with
presenter Professor
Hannes Wachtel.
age. His recommendation was to always make sure
to view new techniques and products critically.
Immediate placement
Professor Georg Mailath-Pokorny (Austria) highlight-
ed aesthetic aspects of the topic. Clinical studies
have shown that recession is three times less likely
when implants are placed further palatally. The tis-
sue biotype seems to have no influence on the re-
sult, which is a novel insight. Professor Gabor Tepper
(Austria) is convinced that not even a dentoalveolar
infection is a limiting factor for immediate implant
placement. But immediate implantation is difficult
in the molar region and downright infeasible with-
out adequate bony structures. Dr Robert Haas (Aus-
tria) believes that immediate implant placement in
the partially edentulous jaw is a suitable method in
the context of implant rehabilitation, even though
the probability of implant loss within the first year
in function is four to six per cent higher than with
conventional procedures.
Risk minimization
Professor Norbert Enkling (Switzerland) showed
that checklists significantly improve the outcomes
of dental implant treatment by lending more struc-
ture to treatment processes. The FOR has already
compiled its first checklists. What if the implant is
already in the wrong position? Dr Peter Wöhrle holds
that explantation is the only solution if the implant
is too close to the adjacent tooth or implant. The
pros and cons of mixed bridges on implant and nat-
ural abutments were discussed by Professor Stefan
Holst (Switzerland) and MDTs Luc and Patrick Rutten
(Belgium). Advantages include the prevention of
augmentation and lower cost to the patient. How-
ever, the clinical success rate of restorations that
also include natural abutments is 77.8 per cent after
ten years in function, which is about 9 per cent low-
er than for strictly implant-supported restorations.
Augmentation procedures pose a risk. For this rea-
son, Professor Georg Watzek (Austria) again alerted
the audience to the benefits of the All-on-4 con-
cept. In his practice, most patients can be treated
with this approach. Only very few patients actually
need augmentation procedures. Dr Falk Wehrhan
(Germany) spoke about the risks posed by bisphos-
phonates. The risk of bisphosphonate-associated
osteonecrosis of the jaw is determined by the un-
derlying disease. Thus, in primary osteoporosis, the
risks of implant therapy are very low, but very high
in the presence of a malignant underlying disease.
A professional follow-up is important for the life ex-
pectancy of the implant-supported rehabilitation.
Dr Christian Lex (Germany) presented his system-
atic follow-up concept.
Soft-tissue stability and aesthetics
Many questions are still open in this area. Professor
Christer Dahlin (Sweden) considers site preservation
using GBR a predictable concept with good long-
term results. When it comes to the use of colla-
gen membranes in GBR, the traditional approach
should be reconsidered. State-of-the-art mem-
branes not only have a passive barrier function,
but they also actively control the wound-healing
process. Treatment plans should refer to a specific
and individual case and take the full potential of
the possible treatment and follow-up into account.
Dr Giorgio Tabanella (Italy) sensitized the audience
as to the various factors to be considered with re-
gard to a long-term aesthetic result. Professor Eric
Rompen (Belgium) explained that the accumulated
collagen fibres on an abutment constitute a very
fragile system. Any disruption of these fibres, as
when removing the abutments, negates the ben-
efits of the one abutment/one time concept. Dr Iñaki
Gamborena (Spain) sees the true challenge in pre-
serving the crestal tissue. The right choice of heal-
ing abutment can stabilize a soft-tissue graft.
Professor Hannes Wachtel (Germany) presented the
laminar bone technique for the regeneration of
larger defects of the buccal bone. This technique
supports the overall attempt to shorten treatment
times. A correct position of the implant in conjunc-
tion with a flapless approach seems to provide sta-
ble peri-implant soft-tissue conditions, according to
Dr Rudolf Fürhauser (Austria). His concept is based
on an “e-point-compliant” navigation that facili-
tates “targeting” the correct tooth length, thus de-
termining the correct implant position.
The two days of deliberations can be summa-
rized in Bertrand Piccard’s words: “Inspire others to
achieve success.” It is this very inspiration that the
top speakers of the Nobel Biocare DACH Sympo-
sium wanted participants to take home – to treat
more patients better.
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98
BUSINESS & EVENTS
5th Annual NYU College of Dentistry Global Implantology Week
by Zimmer Dental and NYU in New York in mid-March 2014
Global Implantology Week
About 380 international participants attended the comprehensive training week in Manhattan hosted
by Zimmer Dental and NYU to learn more about the global subject of oral implantology.
New York University and Zimmer Dental had issued
a joint invitation to the four-day Implantology Week
in New York, which some 380 participants from all
over the world accepted. The city that never sleeps
demonstrated its outstanding host qualities. Multi-
faceted New York is immensely rich in cultural diver-
sity – a perfect parallel to the topic on hand, where
renowned speakers presented on a wide variety of
approaches and techniques in implant dentistry.
Fundamental aspects of bone surgery were the
introductory theme of the four congress days, where
complex issues related to avoiding dehiscence, mu-
cositis or peri-implantitis were illuminated. Insuffi-
cient bone widths, improper implant positions and
a lack of vital bone will always adversely affect the
long-term prognosis. Of all recessions, 82 per cent
are observed on the buccal side, where they will of-
ten be augmented with bone substitute materials
that are not always compatible with the biology of
the vital bone. Autologous bone is a major prerequi-
site for the formation of circumferential vital bone
and helps prevent peri-implantitis and/or bone col-
lapse. Recent research efforts have targeted the
osteocyte interface.
It is likely that less growth factors will be used in
the future, while more emphasis will be placed on
antibodies to the sclerostin that is formed by osteo-
cytes if the bone is not loaded.
Photo: SeanPavonePhoto / Fotolia.com
It is not always true that platform switching, es-
pecially in conjunction with internal conical con-
nections, is the key to bone preservation around the
implant neck. Rather, the constant replacement of
abutments plays a big role, so “one abutment – one
time” concepts are preferable. An impression can be
taken already during surgery, so that the possibility
exists to insert a custom abutment at re-entry.
The Trabecular Metal implant by Zimmer Dental
can be used for different indications in structur-
ally weakened bone. It can be immediately loaded
with a provisional restoration, as its special surface
allows intimate interconnections with the alveolar
bone, something to which the high removal torque
of more than 35 Ncm also attests. Furthermore, if
the aforementioned preconditions exists, a defini-
tive crown can be delivered within two weeks from
implant placement.
A new concept for immediate implant placement
in the anterior region was also introduced. Using
autologous bone grafts obtained from the tuber re-
gion using a special harvesting technique, it is pos-
sible to selectively re-establish lost alveolar bone, so
that defects on adjacent teeth are also reconstruct-
ed. A “triple-graft” procedure was shown where not
only bone but also soft tissue was transplanted. The
Trabecular Metal implant provides great support
because it can be loaded more quickly and is ame-
nable to immediate restoration. Elaborate mould-
ing techniques using stencils and concave cervical
composite areas on the roughened-surface abut-
ments completed the impressive results.
An interesting new access concept in the se-
verely atrophic edentulous posterior maxillary jaw
allowed sinus floor elevation to be realized with
less invasive surgical techniques. Given sufficient
ridge width, a height gain of up to 15 mm can be
achieved with crestal access. In addition, patients
can expect fewer postoperative complications and
complaints than with the conventional fenestra-
tion technique according to Tatum. Late restoration,
 99
BUSINESS & EVENTS

for example using the Revitalize technique, is only
one of many prosthetic options. CAD/CAM-milled
bars offer stress-free solutions as long as certain
requirements are met, such as paying attention to
adequate framework dimensions.
In cantilever restorations, a minimum framework
thickness of 15 mm is required for fracture preven-
tion. The distance from the gingiva must be suffi-
cient to allow adequate oral hygiene. Furthermore,
segmentation of the frameworks in the area of the
first premolars is desirable. Mainly in the mandi-
ble, discrepancies have been noted (due to proper
motion and dimensional changes) that may well
amount to 0.8 mm in the area of the first molars
when the jaw is opened wide.
Long-term success in immediate-placement cases
requires only gentle extraction techniques to mini-
mize socket damage. Similarly, screw-retained pro-
visionals help prevent peri-implantitis. Cement resi-
due that cannot be removed directly after surgery
may compromise short- and long-term success and
acceptable aesthetics. Immediate placement is fea-
sible not only in the anterior region, but also in the
posterior region. Thus, the interradicular septum is
used to provide sufficient stability of the immedi-
ately inserted implant, while the remainder of the
socket is filled with allogeneic bone chips and cov-
ered with a membrane. The results speak for them-
selves; in nine cases out of ten, good primary stabil-
ity seems to be achieved.
The participants received their certificates in a sol-
emn yet relaxed atmosphere at the end of the event.
A tour of the Zimmer Dental plant in Parsippany,
NJ, USA, where the Trabecular Metal implant is
made, was part of the social programme. Partici-
pants were guided through the production centre,
and various training opportunities were identi-
fied, such as the Zimmer Institute and the Cadaver
Course. A harbour tour with brilliant views of Man-
hattan and its skyscrapers, the Statue of Liberty,
Ground Zero and the Brooklyn Bridge completed
the programme. The view of the New York skyline
was as impressive as the Global Implantology Week,
inviting participants to return next year.
Dr Thomas Staudt
More information
www.zimmerdental.com

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 100
BUSINESS & EVENTS
Annual Meeting of AKOPOM and AGKI in Bad Homburg
Gradual knowledge gains
over the years
Dr Lutz Tischendorf reflects on the 64th Annual Meeting of the Working Group for Maxillofacial Surgery
(AGKI) and the 35th Annual Meeting of the Working Group for Oral Pathology and Oral Medicine (AKOPOM)
within the German Society of Oral, Dental and Craniomandibular Sciences (DGZMK) on 29 and 30 May 2014
in Bad Homburg.
Photo: Jo Chambers / Fotolia.com
More than 300 participants attended the meet-
ing in Bad Homburg on the southern slope of the
Taunus mountain range north of Frankfurt to dis-
cuss, under the skilful directorship of Professor Jörg
Wiltfang (Kiel) and Dr Oliver Driemel (Leer), inflam-
mations of the oromaxillofacial region and risks to
dentistry posed by new drugs for dental surgery, as
well as the diagnosis and treatment of oral squa-
mous cell carcinomas. Eleven keynote lectures, two
disputations, 62 short presentations and 29 posters
were supplemented by seminars on basic surgical
techniques, methods for tooth extraction and socket
maintenance and a lunch symposium on ceramic
implants.
On the main topic of “Inflammation”, there were
well-matched main lectures: Professor Jörg Wiltfang
highlighted current knowledge on osteomyelitis of
the jaw. He was referring not only to the now rare
odontogenic forms, but also to systemic autoimmune
and autoinfective chronic forms such as chronic
recurrent multifocal osteomyelitis, where systemic
treatment dominates. Early assessments are easiest
made by MRI. Various aspects of control mechanisms
of bone metabolism and immune response in osteo-
myelitis appear exciting, but a final evaluation is
still pending.
Professor Bilal Al-Nawas (Mainz) presented sys-
tematic knowledge on the influence of bisphospho-
nates and RANKL inhibitors on bone metabolism,
from which he derived measures for the prevention
and treatment of sequelae.
Professor Emeka Nkenke (Halle) explained the cur-
rent state of evidence-based antibiotic prophylaxis
and therapy.
As in previous years, the main topic of “Inflamma-
tion” covered many short presentations on aspects
of bisphosphonate-associated jaw lesions and rel-
evant experimental and clinical studies: pathogen
range implicated in the accompanying inflamma-
tion, the role of Actinomyces, the success rates of
preventive approaches where intervention is re-
quired (plastic defect coverage, a break in medica-
tion, perioperative antibiotics, tube feeding), and
many more.
Other contributions were devoted to the much-
discussed post-bleeding issues under the new
direct anticoagulants with their very short half-
lives in the absence of antagonists and efficacy
testing.
The Research Day and the free lectures brought
many new ideas. Notwithstanding the wealth
of lectures on the main topic, all the AFGI award-
winning posts were recruited from this segment:
Professor Ralf Smeets (Hamburg) and coworkers,
“Reconstruction of cranial bone defects using dif-
ferent silk protein membranes” (best scientific
presentation); Dr Jennifer Rublack and coworkers
(Göttingen), “Evaluation of surface-engineered oral
endosseous implants in the rat model” (best de-
but lecture); Dr Moritz Berger and coworkers (Hei-
delberg), “Evaluation of head movements and cor-
related image artifacts in cone-beam computed
tomography” (best poster).
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102
BUSINESS & EVENTS
Treatment of skin tumours between
surgery and molecular approaches
One section of the meeting was dedicated to skin
tumours. Professor Andreas Kolk (Munich) discussed
interdisciplinary treatment concepts for facial mel-
anomas, emphasizing surgical therapy on the one
hand and new molecular approach opportunities
on the other.
Dr Lutz Tischendorf (Halle) spoke on the Guideline
on Basal Cell Carcinoma and on the controversies
that had accompanied its preparation. He stressed
the primacy of surgical treatment, for which the
already specially qualified oral and maxillofacial
surgeons would appear to be predestined when it
comes to the facial area.
Dr Laura Desch (Vienna) spoke on the use of
hedgehog signalling pathway inhibitors in rare,
extremely advanced basal cell carcinomas that are
inoperable and beyond radiation treatment. There
are many questions still to be resolved with regard
to this novel approach.
Dr Kai Wermker (Münster) used his considerable
rhetorical talent to present on the surgical treat-
ment of skin tumours, which in the facial region
requires special skills and a subtle understand-
ing of plastic reconstructive or epithetic options.
Short presentations showed how multilocular
large basal cell carcinomas can develop under anti-
TNF-α therapy and that the rare basosquamous
cell carcinomas must be strictly separated from
collision tumours.
Professor Jürgen Hoffmann (Heidelberg) discussed
vascular malformations with their various forms
and well-differentiated therapeutic approaches.
New methods
for reconstruction in the oral cavity
The main AKOPOM topic “Squamous cell cercinoma
(SCC) of the oral cavity” was addressed by some quite
remarkable keynote presentations: Professor Franz-
Josef Kramer (Göttingen) discussed diagnosis and
treatment in the year 2014. Significant progress has
been made through the use of new reconstruction
methods with regard to post-treatment quality of
life. Hopes continue to exist for a treatment strati-
fication relying on molecular and aetiological find-
ings. Professor Alexander Berndt (Jena) and Oliver
Felthaus (Regensburg) discussed molecular interac-
tions in the context of tumour-cell invasion and cur-
rent stem cell research. These two experts, who are
engaged in basic research, presented a systematic
view of the current state of knowledge and its im-
portance for diagnosis and therapy. Their thoughts
were exciting, but require repeated in-depth analy-
sis to be fully appreciated.
There was also an abundance of high-quality
short presentations on current issues, such as on
the predictive value of molecular biomarkers, in-
cluding the EGF receptors, for the malignant poten-
tial of pre-neoplasias and (when differentiated into
nuclear and cytoplasmic locations) for tumour ag-
gressiveness, of circulating miRNAs, of tumour stem
cell markers and of immunological characteristics.
Awards
Dr Stephanie Schipmann and coworkers (Münster)
received the AKOPOM award for their “Studies on
dual immunosuppression by FOXP3 expression in
the tumour and recruitment of FOXP3-expressing
T-regulatory cells in squamous cell carcinoma of
the skin and oral mucosa”.
Pros and cons
Disputations have long been conference highlights
with a particularly public appeal. The dispute be-
tween Professors Ralf Schulze (Mainz) and Herbert
Deppe (Munich), moderated by Professor Stephan
Haßfeld (Dortmund), examined whether the use
of cone-beam computed tomography improves
treatment quality. It is impossible to make a sum-
mary statement; only statements differentiated
by area of achievement are conceivable. Both the
radiation exposure during growth and the value
of the expected information for the prognosis of
each treatment should be considered. The dispute
between Dr Frank Striezel (Berlin) and Dr Gerhardt
Iglhaut (Memmingen), moderated by Professor Wil-
fried Wagner (Mainz), explored whether implants
are contraindicated in smokers. Available data were
interpreted quite differently. Conclusions: Following
an individual risk/benefit assessment, possibly sup-
ported by Interleukin-1 measurements and sound
patient education on existing hazards, implant
placement may on occasion be justifiable even in
smokers, despite an increased risk of implant loss.
Once again, my selection means having to do
injustice to a host of other notable contributions.
To the best of my information, these will later be
found in the DZZ abstract volume and on the AGKI
website (www.ag-kiefer.de).
Both scientific societies succeeded in presenting
a programme of high scientific quality and make it
available in appealing surroundings at very reason-
able cost. Regular participants will be able to follow
the gradual knowledge gains made over the years.
So on 14 May 2015 we will once again meet in Bad
Homburg.
Dr Lutz Tischendorf
Halle (www.drtischendorf.de)
The perfect solution for Innovative atraumatical drill design
the internal sinus lift
Easy and safe elevation of the membrane
Reliable stopper system
Magnificent cutting ability

high initial stability for immediate

and early loading
good feeling of fixture implantation
powerful self threading
TS-System
easy to change the path

SS-System

US-System

DEUTSCHE OSSTEM GmbH Mergenthalerallee 25 65760 Eschborn, Germany

www.osstem.de europe@osstem.de Telefon +49 (0) 61 96 - 777 55 -0
104
BUSINESS & EVENTS

Interview with Silvia Albiac, Managing Director at Bego Iberia

A partner to rely on
Bego Iberia was founded in Barcelona in May 2009, ending a period during which the company had been
represented in Spain by MAB Dental. The new company’s first steps were not easy; it had to weather the
full impact of economic crisis in Spain. What had started in a small loft near Barcelona, with four sales
representatives and one assistant, quickly grew into a prospering business thanks to the great acceptance
of the high-quality Bego products. With a very limited marketing budget, most of the growth was generated
by grateful users who recommended the products to fellow colleagues. Bego Iberia is now growing at an
impressive 25 per cent yearly; a staff of 18 caters to the needs of a growing number of clients. Bego’s strong
R&D programme allows for a continuous line of innovations and new products, from new implant designs
such as the current RS/RSX system to top-notch dental digital technologies such as prosthetic CAD/CAM
and guided surgery. Marianne Steinbeck, Project Manager at EDI Journal, spoke with Silvia Albiac, Managing
Director at Bego Iberia.

Bego Iberia was established at a time when the
economic situation in Spain was dramatic – but it
has developed impressively. Let us in on your secret,
please!
It is true that Bego Iberia was created in 2009,
which was a critical phase for the Spanish economy.
On the other hand, Bego has been present in Spain
since 2000. What we did was to create a working
group that was committed to the project and that
was able to offer a high-quality product at an af-
fordable price in a demanding market.
What is so special about the Spanish market that
only a traditionally global company like Bego can
compete successfully?
The Spanish market is highly developed from an
implantological point of view, with accomplished
professionals and high product quality standards.
The existence of strong family-run companies with
a long tradition and considerable experience in the
dental field gives great confidence to the profes-
sional looking for a partner to rely on.
Do Spanish implantologists have special technical preferences in terms of
implant design, surgical protocols or implant-prosthetic concepts?
The typical Spanish implantologist is fully up to date on recent develop-
ments in the global market. With over 120 manufacturers represented in
Spain, the amount of information available on techniques, designs, pro-
tocols etc. is the same as in the rest of the world. As for the preferences,
lately the trend seems to be towards self-tapping implant bodies and
tapered internal connectors, short drilling protocols and more and more
digital solutions for all steps of the process from impression-taking (using
intraoral scanners) to fabricating the restoration (using CAD/CAM).

How would you describe the training situation in oral implantology in your
country, and what can companies such as Bego do to improve the training
of dental students and the continuing education of general dentists?
Spain has an excess of universities trained dentists compared to other
EU countries. The annual number of graduates is higher than is warranted
by the local market. But as far as training in implantology is concerned,
it is clear that both groups need to improve their knowledge and skills in
this specialty. What companies like Bego can do and often will do is col-
laborate with educational centres – public or private – in providing materials,
speakers and activities.

How are you planning to fight super-low-cost implants in an environment

where the financial situation, though improving, is still quite strained?
Low-cost implants have had their day in Spain due to the crisis. The de-
cline in patients has contributed, along with an increased number of den-
tal clinics, to oral implantologists increasingly looking for affordable op-
tions, forcing on the market a general downward price adjustment. Main
concerns with regard to low-cost implants include quality, medium- and
long-term results, and denture fit – key factors of treatment success.

Thank you, Silvia Albiac, for taking the time for this interview.
STE

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Silvia Albiac
106
BUSINESS & EVENTS
In memoriam Dr Peter Geistlich (1927 – 2014)
“Science was his life”
If I were asked to summarise
Dr Peter Geistlich’s achieve-
ments as an entrepreneur
in a single sentence, I would
say this: He led Geistlich into
a new era, created new stan-
dards in patient care and
forged important milestones
in regenerative medicine. But,
for anyone who experienced
his unique personality close
up and witnessed what he
achieved, that does not really
do him justice.
Almost exactly 60 years ago,
after he had been awarded
Dr Peter Geistlich † his doctorate as a chemical
engineer at the Federal Poly-
technic School ETH, Peter
Geistlich joined our Swiss family enterprise in 1954
and shortly afterwards he was appointed to the
Board of Directors. In the years after the war, our
company produced glue, fertilisers and gelatine on
an industrial scale, the emphasis being on technical
progress and growth.
Peter Geistlich joined the Pharmaceutical Divi-
sion in Wolhusen. Quickly, and with great creativity,
he began to search for new products, and, for ex-
ample, as early as 1959 he took out a patent for an
agent against tuberculosis. During the 1970s, he in-
troduced medical body care products and cosmet-
ics. Then in 1974, he took over from his father Paul
Geistlich as chairman of the Board of Directors.
Over the past 60 years, the company has seen
many successes, but there have also been occa-
sional setbacks, such as having to sell the cosmetic
line Mediline and the fertiliser business, and the
discontinuation of gelatine production. But Peter
Geistlich had great vision and was never discour-
aged because he regarded both success and failure
as being two sides of the same coin. He kept a keen
weather eye on the future and repeatedly strove to
break new ground with undaunted enthusiasm.
In the 1980s, by changing strategic direction into
medical technology, Peter Geistlich quietly man-
aged the transformation of our business from an
industrial manufacturer to a modern technology
company. This change was based on the solid foun-
dation of his profound knowledge of bones and col-
lagen as well as his scientific collaborations with
Professor Myron Spector of Harvard University and
Professor Philip J. Boyne of Loma Linda University
in the USA. Two enduring legacies resulting from
both these friendships were the Philip J. Boyne and
Peter Geistlich Professorship in Loma Linda Univer-
sity and the Osteo Science Foundation established
in 2013.
In the 1980s, Philip Boyne was originally seeking
bone replacement material for oral and maxillo-
facial surgery. Peter Geistlich’s idea was to create
new, high-tech products from the bones and col-
lagen which were being processed industrially by
GPAG in Wolhusen. In fact, it soon transpired that
the newly developed products Geistlich Bio-Oss
and Geistlich Bio-Gide could be used successfully
in combination to build up the maxillary bone. Pre-
viously untreatable patients with thin maxillary
bone could now have their bone augmented and
consequently have implants placed. Dental sur-
geons were now able to achieve far more aestheti-
cally pleasing results with these new products.
Over the years, Peter Geistlich extended the con-
cept of biological regeneration to new areas such
as soft-tissue regeneration.
Science was his life. The over 140 patents granted
to Peter Geistlich bear witness to his talent for re-
search. In 2003, Peter Geistlich and his company
founded the Osteology Foundation for the purpose
of researching new possibilities of regeneration
in the field of dentistry. Exchanging experiences
with dedicated scientists was always very impor-
tant to him.
Peter Geistlich was a man with great charisma
and a sense of humour. He had a benevolent and a
tenacious side, allowing his staff great freedom of
action but never quite letting go of the reins. He was
also a social entrepreneur who always promoted
the wellbeing of his employees and he was always
willing to help when the need arose. His humanity
and commitment remain unforgotten.
Dr Andreas Geistlich
President of the Board
Ed. Geistlich Söhne AG
Zeramex (T)apered cleared for U.S. markets

FDA approval
Increasing patient demands for metal-free dental treatment
with ceramic implants know no national boundaries. As the
pioneer for two-piece zirconia implants, the Swiss company
Dentalpoint AG started looking for openings in international
markets in a timely manner.

VED
APPRO

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Thanks to excellent performance and extensive documentation, the U.S.
Food and Drug Administration (FDA) recently cleared Zeramex (T)apered
for U.S. markets. The Swiss are among the very first providers of FDA-ap-
proved two-piece metal-free implants. CEO Jürg Bolleter takes a very posi-
tive view of the future: “Having achieved this pioneering success in less
than ten months makes us proud and confident that we will be able to
establish metal-free implantology worldwide in a sustainable and trend-
setting manner.”

More information
Dentalpoint AG
Hohlstrasse 614 · 8048 Zürich · Switzerland
info@zeramex.com · www.zeramex.com
108
BUSINESS & EVENTS

Interview with Stephan Weber, General Manager of Implant Direct

Real innovations go beyond

mere hardware
Implant Direct may rightly be considered the originator of the “value segment” of the implant market,
which premium implant manufacturers are now entering as well. Implant Direct occupies an attractive
middle ground with regard to price, but also complements its explicitly pragmatic and efficient product
range with its fair price-performance ratio with comprehensive service and on-demand educational offer-
ings. Experts believe that the value segment is currently the one with the largest growth and the broadest
customer demand.

town. Marianne Steinbeck, Project Manager at EDI

Journal, spoke with Stephan Weber, General Man-
ager of Implant Direct.

When entering the European market in 2007, Im-

Stephan Weber
Implant Direct, a major player with branch offices
and representations in the United States and over
26 European countries, is a permanent fixture on the
implantological scene. When the company – now
part of the KaVo Kerr group, which is characterized
by a high level of specialization in a wide variety of
dental areas – entered the market, its innovative ap-
proach included a consistent embracement of on-
line business. And a new product approach: clever
improvements on established implant systems give
rise to solutions that are new but can still be made
available immediately to oral implantologists as
they are compatible with those systems. At EAO in
Rome, Implant Direct will be presenting its portfolio
and ask its customers to join them for a splendid
night out at one of the most prestigious places in
plant Direct established the “value segment”. What
strategy are you pursuing?
Our concept was initially viewed critically, not al-
ways without a certain measure of arrogance. The
“simply smarter” claim we had used from the be-
ginning helped us make the first inroads. Our seg-
ment became a “value segment” through our cus-
tomers, who demanded exactly what we offered.
We presented ourselves as a dynamic company by
proving that good implant quality need not neces-
sarily be connected with runaway prices. That was
truly revolutionary at the time. Today we are firmly
established in the “value segment”, and high-price
vendors are increasingly moving towards our seg-
ment. As, incidentally, are “low-cost” providers ...
Implant Direct is part of the truly enormous KaVo Kerr
group today. Does that not impair your flexibility?
We are actually a part of the DANAHER group,
which also includes Sybron, KaVo, Kerr, Leica, Ormco
and many others. Whenever dentists look around in
their office, they are guaranteed to see one of “our”
devices or materials. We – but more importantly our
customers – benefit from this corporate structure
and the accumulated expertise in dental technol-
ogy. Customers enjoy the diversity and internation-
ality of this group. But the member companies still
operate independently, and the competence em-
bodied in each remains a tangible asset for users.
Who are Implant Direct’s customers today – and tomorrow?
We are witnessing changes in user needs. Many new users are building
their own private practice and need to establish themselves. They have
a different understanding and a different focus. They include patients in
their decision-making processes. They are looking for partners that can
help them be successful in the long term.

What is the role your technical innovations play in this?

Like its predecessors, the new generation needs reliable partners and
efficient and effective systems. It is not just we who contribute technically
innovative solutions – other vendors do that, too. Implant Direct sees itself
as a service provider that allows users to use existing technologies and
platforms for optimizing office routines to offer patients the best possible
solutions. In short: “simply smarter”.

Are there any analyses that show what oral implantologists value? What
do your customers appreciate?
At the top of the list are product improvements and the compatibility
that allows easy access to our systems, closely followed by all-in-one pack-
ages that contain not just the implant itself but all pertinent prosthetic
components. Finally, there are the sophisticated implant types for stan-
dard indications and specific challenges. We have heard much praise for
our interpretation of “trendy topics”, most recently for our conical implant
connections that offer interesting solutions for individual practices and
clinics.

And beyond the hardware? What is expected of a value provider in terms of

education and training?
Even value providers such as Implant Direct have to invest in training
and continuing education. For this purpose, we use the latest technolo-
gies such as videos, web tutorials and social media. We also offer com-
prehensive 24/7 service and are therefore always ready to help solve any
problems that might arise. The younger generation of dentists has its very
own ideas of when they want to deal with an implantological question,
and we need to be present for them using the medium they prefer: con-
sultations in person, by phone or online.

How is Implant Direct doing in the European market? You will be a Gold
“6C:6HN!L:AAI=DJ<=I"DJI
Sponsor at the EAO Congress in Rome in September. 6C98DBEA:I:8DC8:EI#”
We have been very successfully represented in some countries since 9G#J:A><GJC9:G!
OJG>8="ODAA>@DC
2007; in others we started making inroads two years ago. Depending
on the region, we are confronted with very different growth dynam-
ics, which makes things very interesting. Implant Direct is consistently
perceived as a fairly large provider offering good value for money and
good service, a provider who has understood the importance of forging
intelligent alliances in the fields of product development and related
services in the individual markets. Our cooperation with EAO dates back
to 2007; we owe to this congress a good portion of our Europe-wide
reputation. We would like to invite participants from Europe to a very
special event this year, which we will organize on 26 September together
with KaVo at one of the most attractive venues in Rome. Here we will
introduce our new “InterActive” conical implant – I am sure you will find
it exciting.

Thank you, Stephan Weber, for your time and this interview. STE
110
BUSINESS & EVENTS

Straumann Pure Ceramic Implant for metal-free implant treatment

Patients prefer ceramic implants

Dental ceramics are also developing successfully in the area of dental implants. According to Straumann,
increasing numbers of patients are opting for a biocompatible ceramic implant. Based on a European
survey of more than 250 patients, Straumann has identified a trend toward metal-free implant treatment.
According to the findings of this survey, given a free choice, three-and-a-half times more patients would
opt for a ceramic implant restoration than a titanium one.

According to a study,
given a free choice,
three-and-a-half
times more patients
would choose a
ceramic implant.

According to the dental specialist, the Straumann
Pure Ceramic Implants range is designed for treat-
ment of patients with specific requirements. The
implants are particularly suitable for patients who
explicitly want metal-free implant treatment, as
well as those with a thin gingiva biotype or soft tis-
sue recession. In these cases, the ivory-colored ce-
ramic implants are an ideal, highly esthetic alterna-
tive solution to titanium implants.
Predictability is key for successful treatments.
With its ZLA surface, Straumann has succeeded
in developing a surface that is comparable to the
proven SLA surface in terms of osseointegration
properties. Published research data indicate the
same healing pattern, healing time, and bone main-
tenance for the Straumann Pure Ceramic Implants’
patented ZLA and the SLA surface.
Healing time could be reduced to only six to eight
weeks, which is an almost revolutionary feature in
ceramic implants.
In the past, studies have frequently reported frac-
tures of all-ceramic implants from certain manu-
facturers. Straumann Pure Ceramic Implants are
made from high-performance zirconia (Y-TZP), and
all implants are subject to comprehensive 100 per
cent proof testing before distribution, meaning
that Straumann is able to ensure reliable implant
strength.

Straumann Pure Ceramic Implant: a reliable, metal-free alternative to titanium

More information
implants. www.straumann.com
 111
BUSINESS & EVENTS

medentis receives the medical device approval for the Chinese market

ICX-templant conquers China

As recently announced by the China Food and Drug Administration (CFDA), medentis has received medical
device approval for the Chinese market: the ICX-templant has arrived in the Land of the Dragon.

Following the tightening of regulations by the Chi-
nese licencing authority in March 2013, the Chinese
approval process for medical devices has come to
be regarded as one of the toughest and most de-
manding in the world. For licencing, extensive clini-
cal data must be obtained and evaluated and nu-
merous in-vitro tests for mechanical strength and
biocompatibility assessment have to be performed.
medentis medical GmbH and its ICX-templant im-
plant system now have access to one of the world’s
fastest-growing markets with more than 1.3 billion
consumers, further strengthening the position of
medentis medical on the Far Eastern market.
Based on this approval, medentis expects a fur-
ther substantial increase in sales in the medium
term, significantly strengthening the global pres-
ence of the ICX-templant brand.
More information
medentis medical GmbH
Gartenstraße 12 · 53507 Dernau · Germany
info@medentis.de · www.medentis.de

5
Omnia Education Cred
it s
Program

Berlin, Ariana Dental - Design

Course on suturing techniques
12th November 2014
Lecture Hands-on

In this course the participants will learn the main suturing techniques
in oral surgery. Each participant will have the possibility to practice on
models. Different materials and instruments will be explained.
Time will be also devoted to incision techniques, soft tissue management
and tissue graft

Dr. Mario Kirste, MSc

OMNIA S.p.A.
Via F. Delnevo, 190 -
Registration office - Omnia spa 43036 Fidenza (PR) Italy
Tel. +39 0524 527453
oep@omniaspa.eu Fax +39 0524 525230
112
BUSINESS & EVENTS
Modern, mobile, user-friendly
The Dentaurum Group’s new
website is online
The Internet is constantly evolving. New trends and standards are emerging, and what was considered
advanced yesterday is outdated today. This applies particularly to the world of digital communication.
The new website of the Dentaurum Group came on line in early June 2014. The focus of the visual redesign
was on user-friendliness, on new content and on adapting the website to mobile devices.
When defining the new design, the priority was to
focus on essentials. Dentaurum has chosen a con-
sistently appearance for all areas and also found
it important to integrate high-quality graphics dur-
ing the website makeover. The new design stands
out by its clear and neatly arranged page layout on
a predominantly white background.
The navigation has been optimized to enhance
the user-friendliness of the website, which has been
published in seven languages so far. The mouse-
over navigation used to be organized on two lev-
els; now, visitors can navigate across a total of four
levels. This allows visitors to search for information
comfortably – and in a more targeted way. The re-
designed toolbar includes the search function and
new direct links to contacts and press information.
The language selection has also been integrated in
the toolbar. The Dentaurum online shop is acces-
sible in the upper right corner.
Another important point during the relaunch
was to optimize the website for mobile devices. Tab-
let computers and smartphones are enjoying more
and more popularity. According to the online survey
carried out in 2013 by the German public TV chan-
nels ARD/ZDF, the proportion of people accessing
the Internet via their smartphones has grown from
4 per cent (2008) to 45 per cent (2013). For this rea-
son, the new Dentaurum website is now presented
in three versions. The presentation adapts to the
specific requirements of tablets and smartphones
depending on screen size and type,
ensuring unrestricted ease of use
wherever the site is viewed.
The new online world of the
Dentaurum Group is now avail-
able at www.dentaurum.de.
More information
Dentaurum GmbH & Co. KG
Turnstraße 31
75228 Ispringen
Germany
info@dentaurum.de
www.dentaurum.de
 113
BUSINESS & EVENTS

Study proves excellent properties of Roxolid from Straumann

Convincing results
Preclinical and clinical studies prove the high nium ones. This opens up new possibilities in terms
mechanical strength and convincing osseo- of less invasive treatment for patients with limited
bone availability and avoiding complex and expen-
integration properties of Roxolid, Straumann’s
sive bone augmentation. Straumann has been of-
patented dental implant material. fering customers a free upgrade from titanium to
Roxolid since the start of 2014.
Roxolid, a metallic alloy of titanium and zirconium
oxide, has up to 40 per cent higher fatigue strength More information
than equivalent titanium implants (Bernhard et al., www.straumann.com
2009) as well as excellent biocompatibility com-
Roxolid – available
pared to traditional implants. These specific mate- for every application.
rial properties come to the fore in the use of small-
diameter and the new, short 4 mm Straumann
implants in particular. A clinical study by the Uni-
versity of Zurich (Benic et al., 2013) shows the equiv-
alence of 3.3 mm Roxolid implants to 4.1 mm tita-

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Choose the optimal TRIOS® solution for your clinic – Cart, Pod, Chair Integration
www.3Shapedental.com/TRIOS
114
PRODUCT REPORTS
Geistlich Bio-Oss and Geistlich Bio-Gide by Geistlich
Ridge preservation conserves
volume under pontics
Bone resorption after tooth extraction can result in aesthetic and functional problems in the case of a
bridge restoration. Ridge preservation saves more than 90 per cent of the volume.
In the first six months following tooth extraction,
about 50 per cent of the surrounding volume is lost
to alveolar bone resorption (29 % – 63 % horizon-
tal bone loss, 11 % – 22 % vertical bone loss) [1]. The
amount of shrinkage varies from patient to patient.
It is often particularly severe if the tooth loss was due
to trauma or chronic inflammation [2]. If a bridge res-
toration is envisaged to close the gap, loss of volume
can adversely affect the outcome. Especially awkward
are gaps between the pontic and the gingival margin
that are difficult to clean and impair aesthetics and
articulation, especially in the anterior region [2].
Reliable procedure, great effect
Ridge preservation may conserve more than 90 per
cent of the ridge width following tooth extraction
[3]. Therefore, after careful curettage, the cavity is
filled with the Geistlich Bio-Oss Collagen bone re-
placement material and covered with the Geistlich
Bio-Gide collagen membrane. The procedure is non-
invasive and easy to perform.
Study shows 100 per cent patient satisfaction
The impact of ridge preservation under bridges was
gauged in a cross-sectional survey [2]. The patients
Alveolar ridge contour without (left) and with (right) ridge preservation after six months.
received a bridge restoration following ridge pres-
ervation measures. The soft tissue under the pontic
and at the contralateral natural tooth was evalu-
ated by an independent investigator using the pink
aesthetic score (PES). Patient satisfaction was also
evaluated. The treated site and the contralateral
control tooth yielded equally positive results. All
23 patients interviewed declared that they would
opt for ridge preservation again.
References
[1] Tan WL et al. Clin Oral Implants Res. 2012;
23 Suppl 5: 1–21.
[2] Schlee M, Esposito M. Eur J Oral Implantol.
2009; 2(3): 209–217.
[3] Cardaropoli D et al. Int J Periodontics Restorative
Dent. 2012; 32(4): 421–430.
More information
Geistlich Pharma AG
Bahnhofstrasse 40 · 6110 Wolhusen · Switzerland
www.geistlich-biomaterials.com
The product information produced here editorially is
based on information provided by the manufacturer and
has not been checked for accuracy by the editor.
Photo: Dr Stefan Fickl, Germany
116
PRODUCT REPORTS
Orthopantomograph by Instrumentarium Dental
Decades
of patient care
Cone-beam computed tomography (CBCT) has rapidly swept the market and is now used for a wide variety
of diagnostic needs. High-resolution images, a fast and smooth workflow and radiation doses lower than
those of medical CTs are a winning concept and have ensured the breakthrough of CBCT systems. CBCT units
have now been adapted for everyday use at private practices and public clinics in many parts of the world.
However, any discussion of dental and medical im-
aging must consider radiation-related aspects. Pa-
tient exposure is an important ethical factor. The
relationship between radiation dosage and the ac-
curacy of provided diagnostic information has in-
spired the industry to strive for technological inno-
vations to further reduce the radiation risk without
compromising image quality.
The philosophy of Instrumentarium Dental is to fo-
cus on maximal patient care; patient well-being is in-
tuitive and the starting point for all product develop-
ment. As a result, Orthopantomograph (OP) systems
have always been engineered to minimize radiation:
dose reduction was already a concern when the very
first Orthopantomograph unit was marketed in 1961.
Throughout decades, the OP systems have in-
troduced innovations for optimized dosage, e.g.,
collimated paediatric panoramic pro-
grammes, the Automatic Dose Con-
trol (ADC) option and Automatic Facial
Contour (AFC) for soft-tissue definition
within cephalometric scans. All these
Table 1 Source: Patient doses features encourage correct exposure
from dental X-ray exams values, minimizing patient dose while
(Ludlow et al., 2008). optimizing image quality.
In line with this principle, the first
CBCT unit by Instrumentarium Dental,
the Orthopantomograph OP300, al-
ready provided a standard resolution op-
tion in addition to high-resolution and
endo modalities. Standard resolution is
perfect for general diagnostics in most
adult cases, whereas high resolution is
Table 2 Source: OP300 Maxio
suitable for detailed diagnosis and endo
Dosimetry Report, Professor John
B. Ludlow, April 2014. Based on a resolution, with its 85-μm voxel size, re-
5 x 5 cm 3D scan with LDT. veals even minute details for root-frac-
ture analysis. To complement this offering and to
further improve the combination of patient dose
and image quality, the OP300 Maxio, a newcomer
within the Orthopantomograph family, features five
different fields-of-view (FOV) and a Low Dose Tech-
nology (LDT). The LDT programme optimizes im-
age acquisition and exposure parameters for even
lower radiation dose than previously. Current, expo-
sure time, number of projections, voxel size and re-
construction algorithm are individually adjusted for all
OP300 Maxio FOVs utilizing LDT, resulting in a com-
bination of clinically relevant image quality in the
region of interest (ROI) and low dose for the patient.
According to a recent study (Tables 1 and 2),
the effective dose produced by OP300 Maxio LDT
may be as low as one-fifth of a panoramic dose
(FOV: 5 x 5, ROI: maxilla/mandible). The above indi-
cations clearly make Orthopantomograph OP300
Maxio and its LDT programme an attractive solu-
tion. LDT is the perfect tool for implant planning
and third-molar extraction while always preserving
important diagnostic data. In addition, LDT is obvi-
ously ideal for radiation-sensitive paediatric cases
and for control and follow-up situations.
In short, Orthopantomograph excels not only in
image quality, but also when it comes down to pa-
tient care and optimized radiation dose.
More information
Instrumentarium Dental
Nahkelantie 160
04301 Tuusula · Finland
info@instrudental.com
www.instrumentariumdental.com
The product information produced here editorially is
based on information provided by the manufacturer and
has not been checked for accuracy by the editor.
 Image (background): shutterstock / Karramba Production

Our bestseller by Jan Hajtó:

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Natural & Beautiful Teeth

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118
PRODUCT NEWS

Cendres+Métaux Pekkton
Product Its physical properties place it at the
Pekkton top of the quality pyramid for polymers
Indication and make it an excellent choice for den-
Implant-supported restorations tal applications. For example, its com-
Distribution
pression strength is up to 80 per cent
Cendres+Métaux SA higher than that of PEEK. Pekkton is light-
Rue de Boujean 122 weight and slightly radiopaque and pos-
P. O. Box sesses shock-absorbing characteristics,
2501 Biel/Bienne
which makes it suitable for definitive
Switzerland
info@cmsa.ch Pekkton is a high-performance polymer, a framework restorations on implants.
www.pekkton.com material that is an ideal solution for aesthetic, defini- Cendres+Métaux has recognized the
tive and patient-friendly restorations on implants. growing interest in polymers on the in-
It is based on OXPEKK (polyetherketoneketone, or ternational market and quickly moved
PEKK), a material that has been widely and success- to secure the exclusive worldwide rights
fully used for human implants for many years. for Pekkton.

Kohler Flexible drilling gauge

Product The flexible drilling gauge is ideally suited to place The additional “wings” have been pro-
Flexible the pilot drill exactly at the requested position in duced and constructed for distances of
drilling gauge
both fully and partially edentulous jaws: 4 mm and 10 mm, respectively. They sim-
Indication • 4 mm is the ideal clearance from natural teeth. plify the application of the instrument in
Dental • 8 mm is the average clearance from incisors and the dentate jaw.
implantology premolars.
Distribution • 10 mm correspond to the average molar clearance.
Kohler
Medizintechnik GmbH & Co. KG
Bodenseeallee 14 – 16
78333 Stockach · Germany
info@kohler-medizintechnik.de
www.kohler-medizintechnik.de

Ushio TheraBeam SuperOsseo

Product Ushio, a Japanese lighting specialist, is introducing plants with UV irradiation to improve
TheraBeam SuperOsseo the next generation of implant therapy, the Thera- surface characteristics immediately prior
Indication
Beam SuperOsseo medical device that treats im- to implantation. This process, called
Conditioning of dental implants photofunctionalization, enhances the
strength of osseointegration and op-
Distribution
Ushio Europe B.V. timizes bone-to-implant contact com-
Breguetlaan 16 - 18 pared to untreated implants. Preclinical
1438 BC Oude Meer and clinical studies showed more than
The Netherlands
three times faster osseointegration,
info.medical@ushio.eu
www.ushio.eu more than 25 per cent improved implant
anchorage and a more than 50 per cent
reduction in healing time.
 119
PRODUCT NEWS

Kohler Minvalux Black

It is possible nowadays to extract a tooth or a root • Microscopically smooth surface – Product
and place an implant immediately afterwards, pro- notably improved corrosion resistance Minvalux Black

vided that the appropriate indications for this pro- • Reduced friction factor for lower wear Indication
cedure are observed. To ensure that the extraction • Tissue-friendly and biocompatible Extraction surgery
is performed as atraumatically as possible, the sur- ceramics Distribution
geon must have suitable instruments at his or her • Anti-allergenic function Kohler
disposal. Medizintechnik GmbH & Co. KG
Bodenseeallee 14 – 16
Minvalux Black instruments with an ergonomic
78333 Stockach · Germany
Trinovo instrument handle and a ceramic coating info@kohler-medizintechnik.de
have a single working end and are designed espe- www.kohler-medizintechnik.de
cially for minimally invasive extraction surgery.

Advantages of the ceramic coating:

• Extremely durable and long-lasting
• Tremendous abrasion resistance
• Anti-glare surface – no disturbing light reflections

Past << Future: Envision 77 Heart Beats Crown – Bridge & Implants: The Art of Harmony
by Naoki Hayashi by Luc Rutten & Patrick Rutten

Master ceramist Naoki The authors show the way

Hayashi presents a portfolio to a perfect red and white
of beautiful restorations in a esthetic by using pictures
unique book reflecting his high and a cross section out of
quality work and unique style. their daily work in the
laboratory.
320 pages with excellent four
color photographs 296 pages, 1300 pictures

349,– € 99,– €
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Individualitas Naturae Dentis 3D Composites – Natural Shading & Shaping

by Knut Miller by Ulf Krueger-Janson

This valuable workbook Contains an instruction sheet

supports and inspires dentists for an uncomplicated layer
in their quest to consciously construction as well as hints
replicate the individual shapes for the correct handling of the
of the natural tooth. appropriate materials and
tools.
139 pages, 154 pictures
264 pages, 1300 pictures
154,– €
plus shipping 178,– €
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120
CALENDAR OF EVENTS

Calendar of Events

Event Location Date Details/Registration

9/2014 EAO Annual Scientific Congress Rome 25–27 September 2014 European Association for
Italy Osseointegration
www.eao.org

Dental-Expo 2014 Moscow 29 September– Crocus Expo IEC

Russia 2 October 2014 www.dental-expo.com

10/2014 4th Champions Congress Frankfurt 3–5 October 2014 Champions-Implants

Germany www.championsimplants.com

Pragodent 2014 Prague 9–11 October 2014 Incheba Praha

Czech Republic www.pragodent.eu

BDTA Dental Showcase 2014 London 9–11 October 2014 British Dental Trade Association
England www.dentalshowcase.com

Osstem World Meeting Busan 18–21 October 2014 Osstem

South Korea www.osstem.de

11/2014 Swedental 2014 Stockholm 11–15 November 2014 Stockholmsmässan

Sweden www.swedental.org

27th National and 20th Inter- Madrid 13–15 November 2014 Sociedad Española de Implantes (SEI)
national Congress of the Spanish Spain www.seimadrid2014.es
Society of Implants (SEI)

ADF Annual Dental Meeting Paris 25–29 November 2014 Association Dentaire Française
France www.adfcongres.com

2/2015 Chicago Dental Society Chicago 26–28 February 2015 Chicago Dental Society (CDS)
Midwinter Meeting USA www.cds.org

3/2015 36th International Dental Show Cologne 10–14 March 2015 Koelnmesse GmbH
Germany www.ids-cologne.de

EDI – Information for authors

EDI – the interdisciplinary journal for prosthetic dental implantology is aimed at den-
tists (and technicians) interested in prosthetics implantology. All contributions submit-
ted should be focused on this aspect in content and form. Suggested contributions
may include:
· Case studies
· Original scientific research
· Overviews
Manuscript submission
Submissions should include the following:
· two hard copies of the manuscript
· a disk copy of the manuscript
· a complete set of illustrations
Original articles will be considered for publication only on the condition that they have
not been published elsewhere in part or in whole and are not simultaneously under
consideration elsewhere.
Manuscripts
Pages should be numbered consecutively, starting with the cover page. The cover page
should include the title of the manuscript and the name and degree for all authors.
Also included should be the full postal address, telephone number, fax number, and
electronic mail address of the contact author. The second page should contain an ab-
stract that summarizes the article in approximately 100 words.
Manuscripts can be organized in a manner that best fits the specific goals of the ar-
ticle, but should always include an introductory section, the body of the article and a
conclusion.
Figures and tables
Each article should contain a minimum of 20 and a maximum of 50 original color
slides (35 mm) or digital photos, except in unusual circumstances. The slides will be
returned to the author after publication. Slides should be numbered on the mount in
the sequential numerical order in which they appear in the text (Fig. 1, Fig. 2, etc.). Ra-
diographs, charts, graphs, and drawn figures are also accepted. Figure legends should
be brief one or two-line descriptions of each figure, typed on a separate sheet following
the references. Legends should be numbered in the same numerical order as the fig-
ures. Tables should be typed on separate sheets and numbered consecutively, according
to citation in the text. The title of the table and its caption should be on the same sheet
as the table itself.
References
Each article should contain a minimum of ten and a maximum of 30 references, except
in unusual circumstances. Citations in the body of the text should be made in numeri-
cal order. The reference list should be typed on a separate sheet and should provide
complete bibliographical information in the format exemplified below:
[1] Albrektsson, T.: A multicenter report on osseointegrated oral implants. J Prosthet
Dent 1988; 60, 75-82.
[2] Hildebrand, H. F., Veron, Chr., Martin, P.: Nickel, chromium, cobalt dental alloys and
allergic reactions: an overview. Biomaterials 10, 545-548, (1989).
[3] Johanson, B., Lucas, L., Lemons, J.: Corrosion of copper, nickel and gold dental alloys: an
in vitro and in vivo study. J Biomed Mater Res 23, 349, (1989).
Review process
Manuscripts will be reviewed by three members of the editorial board. Authors are
not informed of the identity of the reviewers and reviewers are not provided with the
identity of the author. The review cycle will be completed within 60 days. Publication is
expected within nine months.
Page charges and reprints
There are no page charges. The publisher will cover all costs of production and provide
the primary author with five free copies of the journal issue in which the article ap-
pears.
Editors office:
teamwork media GmbH, Hauptstr. 1, 86925 Fuchstal/Germany
Phone: +49 8243 9692-0, Fax: +49 8243 9692-22
service@teamwork-media.de
MEMBERSHIP REGISTRATION FORM

I hereby apply for a membership in the BDIZ EDI The annual membership fee for:
(European Association of Dental Implantologists)

Name: .................................................................................... FULL MEMBERSHIP

Full member - clinical 345,00 Euro

First Name: ............................................................................
Assistant dentist / young professional 172,50 Euro
(up to 5 years after graduation)
Country: ................................................................................
172,50 Euro
Second membership / family member

Zip code / City: …..................................................................

EXTRAORDINARY MEMBERSHIP

Street: ……………………………………………………….…...
Co-operative Member
(Professionals without practice 165,00 Euro
and dental technicians)
Phone: …………………………………………………….….....
Students non-contributory

Fax: .........................................................................…..........
Supporting Membership 530,00 Euro
(Companies etc.)

E-Mail: .......................................... @ …...............................

Payment
Homepage: ………………………….………………….………. Membership cannot be confirmed until payment is processed. Method of
payment is by bank transfer. Please use the following banking account.

Date of Birth: ......................................................................... Commerzbank Bonn

Account Number: 310 144 100

Practicing implantology since: …........................................... Bank Code: 380 400 07
IBAN: DE96 3804 0007 0310 1441 00
BIC: COBADEFFXXX

Membership cards will be sent upon receipt of the annual

Member of other Societies: subscription fee.

ICOI BDO DGI DGZI DGMKG EAO

City / Date : …………………………………………………

Continuing education Courses: ................................................

Seal / Signature: ....................................................................

...................................................................................................

Fellowship status / diplomate status in implantology Please return the completed registration form to:

European Association of Dental Implantologists e. V.

Yes No Organization ………...……….. An der Esche 2 ƒ D - 53111 Bonn
Fon: + 49 (0) 228-93592-44
Fax: + 49 (0) 228-93592-46
Entry in BDIZ EDI Directory: Yes No E-Mail: office-bonn@bdizedi.org
(For information on BDIZ EDI Directory of Implant Dentists see overleaf) Homepage: www.bdizedi.org

BDIZEDIƔAnderEsche2ƔDͲ53111BonnƔTel.++49(0)228Ͳ9359244ƔFax++49(0)228Ͳ9359246
officeͲbonn@bdizedi.orgƔwww.bdizedi.org
THE MAKING OF A

ZEST’s LOCATOR® Attachment

represents a rare occurrence
in the implant field. Never before
have industry players, clinicians,
and patients come together
to universally recognize the
merits of a restorative solution.
It has allowed the LOCATOR
to become the most globally
recognized and trusted brand
for overdenture restorations.

INDUSTRY WIDE
SOLUTION
ZEST recognizes, and is honored by, the commitment implant
companies have made to make the LOCATOR Attachment
compatible with their dental implants. In fact, the dental
implant companies that collectively make up over 90% of
the global implant market supply, partner with ZEST Anchors.
Each has chosen the LOCATOR to be a part of the solutions
they provide to you, their customer, and your patients.
 CLINICIAN
PREFERENCE
LOCATOR’s unique low profile design, pivoting technology,
durability, and ease-of-use has propelled it to be the preferred
choice of clinicians world-wide for tissue supported, implant-
retained overdentures. Clinicians have validated LOCATOR’s
Gold Standard status with over 4 million units purchased - no
other product can match its extensive clinical documentation,
design accolades or number of satisfied patients.

PATIENT
SATISFACTION
Every day new patients begin a journey of being able
to eat, laugh and speak with confidence again. Today,
over two million patients are enjoying an improved
quality of life by trusting their clinician to secure
their restoration with LOCATOR.

TOGETHER WE CAN MAKE

TOMORROW EVEN BETTER
The trust and confidence placed in ZEST since its inception in 1972 is not taken lightly.
It enhances our company’s commitment to clinicians, our implant company partners and
your patients. Together we will continue to provide more options for the treatment of
patients who suffer from the real-life problems associated with edentulisim.
Stay close to ZEST for soon-to-be released innovations that can improve and expand
the clinical solutions available within the LOCATOR Portfolio of products.

To experience for yourself how LOCATOR became the Gold Standard of

resilient attachment systems, and for a listing of ZEST LOCATOR Partners,
please visit zestlocator.com or call 800-262-2310.

i=(67$QFKRUV//&$OOULJKWVUHVHUYHG/2&$725DQG=(67DUHUHJLVWHUHGWUDGHPDUNVRI=(67,3+ROGLQJV//&
 32670003-USX-1402 © 2014 DENTSPLY. All rights reserved
Restoring happiness
Patients rely on you in order to eat, speak, and smile
with confidence. It can be said, you are actually
restoring happiness.
To succeed, you need technology that is well founded
and documented in science. That is why we only deliver
premium solutions for all phases of implant therapy,

These products may not be regulatory cleared/released/licensed in all markets.

which have been extensively tested and clinically proven
to provide lifelong function and esthetics.
Moreover, with an open-minded approach, we partner
with our customers and offer services that go beyond
products, such as educational opportunities and
practice development programs.
Reliable solutions and partnership for restoring
happiness—because it matters.

www.dentsplyimplants.com